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  1. Llamas—Yes, Llamas—Could Help Us Fight Covid-19 These creatures have evolved special "nanobodies" that may have an edge over human antibodies when it comes to developing a new treatment. Photograph: Alamy Millions of years ago, some unknown common ancestor of today’s llamas, camels, and alpacas underwent an unusual genetic mutation. This evolutionary happenstance gave llamas and their kin a strange type of antibody that no other mammals have—which, surprisingly, could end up aiding in the fight against Covid-19. On Monday, in the journal Nature Structural & Molecular Biology, researchers from the Rosalind Franklin Institute and the University of Oxford reported the discovery of two llama antibodies, also called nanobodies, that could prevent the virus that causes Covid-19 from infecting human cells. “These [nanobodies] can block—do block quite potently—the interaction between the virus and the human cell,” says Ray Owens, a professor of molecular biology at the University of Oxford and one of the study’s senior authors. “They basically neutralize the virus.” Like all antibodies, the nanobodies that Owens and his team developed have the ability to recognize and attach to a specific spot on a specific protein—in this case, the so-called spike proteins that cover the surface of the novel coronavirus. When these spikes latch onto ACE2, a protein that sits on the outside of many human cells, the coronavirus can enter and infect those cells. If, however, the spike proteins are blocked from attaching to ACE2, the virus will float around harmlessly, unable to invade. Most species, including humans, make very similar antibodies. Typically, antibodies developed for medical treatments are first produced in lab animals such as rabbits, then isolated and genetically tweaked to more closely resemble human antibodies. But a few species, including llamas, their fellow camelids, and sharks, are antibody oddballs. These animals make nanobodies, so called because they are substantially smaller than their antibody cousins. These tiny molecules have their own particular benefits. “Sometimes there might be a particular pocket that forms on the surface of a protein that's recessed,” says Jason McLellan, an associate professor of molecular biosciences at the University of Texas at Austin who has also discovered a llama nanobody that blocks the spike protein from binding to ACE2. Larger antibodies, he says, “can't bind inside that pocket.” Even when they are used in exactly the same spots, nanobodies may have an edge over human antibodies. “They're very stable,” Owens says. Unlike most antibodies, they maintain their shape in extreme environments, like the human stomach. Given these advantages, nanobodies have been developed as treatments for diseases, and one has even been approved by the FDA as a cancer treatment. The tried-and-true method of developing nanobodies involves injecting a harmless chunk of the pathogen into a llama and waiting for the animal to mount an immune response. But inoculating a llama and extracting its nanobodies is a monthslong process, slow by the standards of Covid-19-era research. So Owens and his colleagues took a different tack. They started with an enormous set of nanobodies that had previously been isolated from llamas. “We have a whole collection of different sequences with different binding potentials,” says Owens. They then used the spike protein to “fish out” any nanobodies that would attach to it. This strategy allowed them to quickly identify a nanobody that had potential against SARS-CoV-2. Unfortunately, this nanobody didn’t attach to the protein tightly enough to effectively block the novel coronavirus from entering cells. So Owens and his team randomly mutated the region of the nanobody that connected with the spike protein, in hopes of creating a snugger fit. And they succeeded: In the presence of large enough quantities of one of these mutated nanobodies, SARS-CoV-2 was entirely incapable of entering human cells. “They literally can't develop infection,” Owens says. McLellan and his team, who published their nanobody discovery in Cell in May, leveraged a different strategy. They were already developing a nanobody against SARS-CoV-1, the virus that caused the 2002–04 SARS epidemic; fortuitously, they found that this same nanobody proved effective against SARS-CoV-2. While their nanobody has the advantage of being effective against multiple coronaviruses, the approach favored by Owens and his colleagues may have its own virtues. “Generally, in order to get breadth, you give up some potency or specificity against any one particular molecule,” McLellan says. “It’s a delicate balance.” Because Owens and his team optimized their nanobodies for use on SARS-CoV-2, they could prove more effective against it—though further research is needed. Regardless of which type of nanobody comes out on top, two may be better than one for Covid-19 treatment. “These two nanobodies could be used simultaneously, to maybe generate an additive or synergistic effect,” McLellan says. Since the nanobodies discovered by each group attach to the spike protein at different spots, when used in concert they could team up to make it even harder for the spike to connect with ACE2. These quick methods of adapting old nanobodies for new purposes are stopgap measures. Scientists are still waiting for the llamas that they have exposed to the spike protein to produce their own SARS-CoV-2 nanobodies from scratch: Both Owens and McLellan are currently working on such projects. “Using immunization, the natural immune system, to mature high affinity interactions obviously gives you the best binders,” Owens says. In the meantime, both researchers hope that their nanobodies might prove to be effective treatments for people who are severely ill with Covid-19. While a patient’s immune system struggles to mount an adequate immune response, nanobodies and other types of antibodies could function as an emergency measure to prevent SARS-CoV-2 from entering more of their cells. The same rationale is behind treatments that involve injecting a patient with plasma from a Covid-19 survivor, but transfusions come with a risk of infection and depend on donations. Until a vaccine becomes available, some researchers believe antibody treatments could be used as short-term protection for health care workers and the families of patients. One they reach the clinical stage, nanobodies might be more convenient to work with than other antibodies. Because they are so small, they can travel much more easily through body tissues, so they wouldn’t necessarily have to be injected into patients. “Potentially, they could be inhaled directly into the lung, where the respiratory infections are occurring,” says McLellan. “They’re also much easier to make,” Owens says. Their small size means that they can be produced in bacteria—much more cheaply and more quickly than standard antibodies, which must be made in animal cells. Jacob Glanville, president and CEO of Distributed Bio, a biotech company that is developing traditional antibodies for use against the novel coronavirus, believes that the ease of producing nanobodies is a material point in their favor. “I think that is a legitimate advantage,” he says. “I’m very concerned about the global capacity to produce CHO,” or Chinese hamster ovary cells, which are used to generate larger antibodies at scale. In the long run, McLellan hopes that llama antibodies can help to prevent a pandemic like Covid-19 from ever happening again. “I think one of the next steps is to start trying to identify antibodies and nanobodies that can broadly bind and neutralize diverse coronaviruses,” McLleland says. “In the event there's another coronavirus outbreak in the future, we might then already have the antibody immediately, from day one, that could work and neutralize the virus.” Llamas—Yes, Llamas—Could Help Us Fight Covid-19
  2. COVID-19 vaccine must protect 50% of people for approval, FDA says FDA sets rules for vaccine approval amid concern of hastiness and political pressure. Enlarge / Stephen Hahn, Commissioner of Food and Drugs at the US Food and Drug Administration (FDA), speaks during a Senate Health, Education, Labor and Pensions Committee hearing on June 30, 2020, in Washington, DC. Getty | Al Drago 59 with 49 posters participating Any experimental COVID-19 vaccines aspiring to earn regulatory approval from the Food and Drug Administration will need to prevent or decrease the severity of disease in at least 50 percent of people, the agency announced Tuesday. The criterium is part of a larger set of guidelines released by the agency for developing a vaccine to halt the spread of pandemic coronavirus, SARS-CoV-2—which causes COVID-19 and is now accelerating in much of the country after months of sustained devastation. With the guidelines, the FDA tried to dispel fears that the rush to develop a COVID-19 vaccine may come at the expense of adequate safety testing. “We recognize the urgent need to develop a safe and effective vaccine to prevent COVID-19,” FDA Commissioner Stephen Hahn said in a statement. “While the FDA is committed to expediting this work, we will not cut corners in our decisions and are making clear through this guidance what data should be submitted to meet our regulatory standards.” Exceptions The agency also hopes to assuage concerns that it has succumbed to political pressure from the Trump administration in making regulatory decisions during the pandemic—eschewing its reliance on efficacy and safety data. Most notable is the case of hydroxychloroquine, a malaria drug known to have severe potential side effects, including triggering potentially fatal heart arrhythmias. Despite a lack of evidence for its efficacy against COVID-19, President Trump touted the drug as a “game changer” and even admitted to taking it himself. The FDA made the unusual decision to issue an Emergency Use Authorization (EUA) for hydroxychloroquine and the related drug, chloroquine, in late March. The EUA allowed doctors to use the drugs to treat COVID-19 patients outside of clinical trials, despite the lack of the evidence. As data piled up that the drugs are ineffective against COVID-19 and come with serious risks, the FDA revoked the EUA in mid-June. Though political leaders, health experts, and media reports have suggested the Trump administration influenced the FDA’s initial decision to issue an EUA, Hahn has denied this. In a Congressional hearing June 23, he testified that “I have not felt political pressure nor has the FDA to make any decision in any specific direction.” He echoed the point in today’s announcement of the vaccine guidelines, saying “We have not lost sight of our responsibility to the American people to maintain our regulatory independence and ensure our decisions related to all medical products, including COVID-19 vaccines, are based on science and the available data.” In the announcement, the FDA noted that, although the guidelines lay out what’s needed for full approval, the agency may still consider issuing an EUA to candidate COVID-19 vaccines on a “case-by-case” basis. The agency said it would consider an EUA based on “the target population, the characteristics of the product, and the totality of the relevant, available scientific evidence, including preclinical and human clinical study data on the product’s safety and effectiveness.” COVID-19 vaccine must protect 50% of people for approval, FDA says
  3. China moves forward with COVID-19 vaccine, approving it for use in military Early trial data suggests that vaccine is safe, but efficacy still unclear. Enlarge / Chinese President Xi Jinping learns about the progress on a COVID-19 vaccine during his visit to the Academy of Military Medical Sciences in Beijing on March 2, 2020. Getty | Xinhua News Agency 31 with 28 posters participating China has approved an experimental COVID-19 vaccine for use in its military after early clinical trial data suggested it was safe and spurred immune responses—but before larger trials that will test whether the vaccine can protect against SARS-CoV-2 infections. This marks the first time any country has approved a candidate vaccine for military use. China’s Central Military Commission made the approval June 25, which will last for a year, according to a filing reported by Reuters. The vaccine, developed by biotech company CanSino Biologics and the Chinese military, is a type of viral vector-based vaccine. That means researchers started with a viral vector, in this case a common strain of adenovirus (type-5), which typically causes mild upper respiratory infections. The researchers crippled the virus so that it doesn’t replicate in human cells and cause disease. Then, they engineered the virus to carry a signature feature of SARS-CoV-2—the coronavirus’s infamous spike protein, which juts out from the viral particle and allows the virus to get a hold on human cells. The idea is that, when the harmless vaccine virus is injected into the body, it will essentially present the SARS-CoV-2 spike protein to the immune system, which can then develop anti-SARS-CoV-2 responses. Those include antibodies, which are Y-shaped proteins that surveil the body and detect previously encountered germ invaders by key features. Once a germ is detected, neutralizing antibodies can glom onto the germ and prevent it from sparking an infection. In a Phase 1 safety trial involving 108 people, the vaccine—dubbed Ad5-nCoV—proved safe and was able to spur the production of neutralizing antibodies and other immune responses. However, the study, published in The Lancet, also detected a potential foil for the vaccine candidate: in people who had been infected with Ad5 in their past, the vaccine didn’t generate as strong of a response to SARS-CoV-2’s spike protein. This may be because their immune systems quickly recognized the adenovirus and focused their responses on the viral vector, rather than the nefarious spike. CanSino said it had since completed a larger Phase 2 trial, looking at safety and efficacy, but has yet to release results, according to the South China Morning Post. The paper also noted that CanSino has reached an agreement with the Canadian government to conduct Phase 3 trials there. Those trials will look at efficacy and potential side effects in an even larger group of people. In the meantime, CanSino declined to say if members of the Chinese military would be required to receive the experimental vaccine or if it would be optional, according to Reuters. According to the latest tally by the World Health Organization, there are 17 COVID-19 vaccine candidates in clinical trials and 132 others in pre-clinical development. Many vaccines are being developed in China, but with the now-limited spread of the coronavirus there, researchers are working to conduct vaccine trials elsewhere, in areas still seeing heavy transmission. China moves forward with COVID-19 vaccine, approving it for use in military
  4. BEIJING (Reuters) - A Beijing district put itself on a “wartime” footing and the capital banned tourism and sports events on Saturday after a cluster of novel coronavirus infections centred around a major wholesale market sparked fears of a new wave of COVID-19. Forty-five people out of 517 tested with throat swabs at the Xinfadi market in the city’s southwestern Fengtai district had tested positive for the coronavirus, Chu Junwei, a district official, told a briefing. None were showing symptoms of COVID-19, he said, but added that 11 neighbourhoods in the vicinity of the market, which claims to be the largest agricultural wholesale market in Asia, had been locked down with 24-hour guards put in place. “In accordance with the principle of putting the safety of the masses and health first, we have adopted lockdown measures for the Xinfadi market and surrounding neighbourhoods,” Chu said. The district is in a “wartime emergency mode,” he added. The closure of the market and new restrictions come as concerns grow about a second wave of the pandemic, which has infected more than 7.66 million people worldwide and killed more than 420,000. They also underline how even in countries which have had great success in curbing the spread of the virus, clusters can sometimes easily arise. The entire Xinfadi market was shut down at 3 a.m. on Saturday (1900 GMT on Friday), after two men working at a meat research centre who had recently visited the market were reported to have the virus. It was not immediately clear how they had been infected. People are wearing face masks inside the Jingshen seafood market which has been closed for business after new coronavirus infections were detected, in Beijing, China, June 12, 2020. On Saturday, market entrances were blocked and police stood guard. Beijing authorities had earlier halted beef and mutton trading at the market and had closed other wholesale markets around the city. They plan for more than 10,000 people at the Xinfadi market to take nucleic acid tests to detect coronavirus infections. According to the Xinfadi website, more than 1,500 tonnes of seafood, 18,000 tonnes of vegetables and 20,000 tonnes of fruit are traded at the market daily. TOURIST SITES CLOSE A city spokesman told the briefing that all six COVID-19 patients confirmed in Beijing on Friday had visited the Xinfadi market. The capital will suspend sports events and tourists from other parts of China, effective immediately, he said. In Nanjing, capital of the eastern province of Jiangsu, a local association of restaurants said it would halt the serving of foods containing raw seafood or animal products. Some Beijing residents, including a man shopping at a Carrefour supermarket in Fengtai district, said they were confident authorities had the situation under control. “If I were worried, I wouldn’t come here to buy meat. I believe it has been quarantined,” said the man, who gave his surname as Zhang. Beijing’s Yonghe temple and National Theatre also announced they would close from Saturday, and the city government said it had dropped plans to reopen schools on Monday for students in grades one through three because of the new cases. One person at an agricultural market in the city’s northwestern Haidian district also tested positive for the coronavirus, Chu said. Highlighting the new sense of alarm within the city, health authorities visited the home of a Reuters reporter in Beijing’s Dongcheng district on Saturday to ask whether she had visited the Xinfadi market, which is 15 km (9 miles) away. They said the visit was part of patrols Dongcheng was conducting. And following reports in state-run newspapers that the coronavirus was discovered on chopping boards used for imported salmon at the market, major supermarkets in Beijing removed salmon from their shelves overnight. That concern also spread to other cities, with a major agricultural wholesale market in Chengdu, the capital of the southwestern province of Sichuan, saying it would remove salmon products from its shelves from Saturday. Slideshow of 8 images at the Source Source
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  6. The COVID-19 pandemic has led to a significant drop in emergency room visits among patients with other ailments, the Centers for Disease Control and Prevention said. Visits to hospital U.S. emergency rooms have dropped by more than 40 percent so far in 2020, compared to the same period last year, according to figures released Wednesday by the U.S. Centers for Disease Control and Prevention. The statistics indicate that a significant number of Americans may have delayed or declined emergency care because of the COVID-19 pandemic, the agency said. In their analysis of ER visit trends, CDC researchers analyzed data from the National Syndromic Surveillance Program for the period of Jan. 1 through May 30. The program includes data from all U.S. states except Hawaii, South Dakota and Wyoming. Changes in how hospitals, and specifically ERs, are used could be a lasting legacy of the new coronavirus, according to some public health experts. Many patients who once addressed health concerns by heading to the ER could be managed remotely, using telemedicine, Dr. Paul Biddinger, during a conference call with reporters on May 26. Biddinger, vice chair for emergency preparedness in the Department of Emergency Medicine at Massachusetts General Hospital, was not part of the CDC analysis. "People have been working for years, probably really fair to say decades, on telemedicine, when it's appropriate for patients not to have to come to the hospital, but they can see their doctor remotely," Biddinger said. "And the pandemic forced a lot of that on us," he said. The CDC researchers compared total visits so far this year to the same five-month period in 2019. The number of ER visits declined from a mean of roughly 2.1 million per week between March 31, 2019, and April 27, 2019, to a mean of 1.22 million per week during the "early pandemic" period of March 29 to April 25 of this year, according to the CDC. ER visits declined for every age group, with the largest proportional declines in children 10 years old and younger at 72 percent and children 11 to 14 years old at 71 percent, the agency said. Researchers found the largest declines in ER visits occurred in the New England states at 49 percent, as well as in the mid-Atlantic region at 48 percent. That region includes New York and New Jersey, which has been the epicenter of the U.S. COVID-19 outbreak. ER visits related to abdominal pain and other digestive problems fell by more than 66,000 per week from year to year, while those among patients reporting musculoskeletal pain -- excluding low-back pain -- dropped by more than 52,000 per week, according to the CDC report. Visits for "sprains and strains" declined by nearly 34,000 per week, and those related to "superficial injuries" fell by nearly 31,000 per week, the researchers said. Conversely, ER visits for "exposure, encounters, screening or contact with infectious disease" increased by nearly 19,000 per week from 2019 to 2020, the analysis found. Specifically, some 18,000 ER visits occurred per week across the country for COVID-19 symptoms through the end of May, the researchers said. Still, additional research is needed to determine whether the decline in ER visits could be also attributed to "actual reductions in injuries or illness [due] to changing activity patterns during the pandemic" lockdown, the CDC researchers wrote. "The striking decline in [ER] visits nationwide, with the highest declines in regions where the pandemic was most severe, suggests that the pandemic has altered the use of the [ER] by the public," researchers said. Source
  7. A troop of monkeys snatched the blood samples of suspected coronavirus patients at a government hospital in the Meerut district of the north Indian state of Uttar Pradesh. The incident happened on Thursday when a lab assistant working with the COVID-19 facility of the hospital was carrying blood samples due for testing, Dr Dheeraj Baliyan, medical superintendent of Lala Lajpat Rai Memorial Medical College and Hospital, told CNN. The monkeys attacked the lab assistant and stole the sample box with three samples, added Baliyan. A file image of a long-tailed macaques kept for use in the clinical research inside cages. (AP/AAP) S.K. Garg, head of the hospital, told a local newswire that the samples were blood samples, and not the swabs usually taken to test for COVID-19. Garg said that the samples belonged to people who had tested positive for COVID-19, but were taken as part of routine blood tests for the patients. The monkeys climbed the trees with the samples and threw them after chewing the packets, Baliyan added. The medical superintendent confirmed to CNN that no individual came into contact with the samples, and the hospital authorities have sanitised the area and disposed of the samples snatched by the monkeys. The district administration has ordered an inquiry against the hospital authorities for alleged mishandling of the samples. According to India's health ministry, the total number of coronavirus cases in the country as of Friday stands at 165,799, including 4,706 deaths. Source
  8. 3D printers are on the front lines of the COVID-19 pandemic InOn March 20th, as the coronavirus situation in New York City hurtled toward full-blown crisis, Madiha Choksi was packing a taxi with two Flashforge 3D printers and as much filament as she could fit. Choksi, a librarian specializing in research and educational technology, had received an urgent email the night before from Pierre Elias, a cardiology fellow at NYP-Columbia University Medical Center. Elias desperately needed to produce more protective gear for hospital workers treating COVID-19 patients. He hoped Choksi, the administrator for Columbia University’s 3D printing lab, might be able to help. “The email was very long and really concerning,” Choksi tells The Verge. Normally, she could help. “But I don’t have any printers,” she remembers thinking, “and we were already on day three or four of remote work.” Thankfully, Columbia handed over its printers. “Within hours, they were like, ‘Yeah, of course,’” she says. Choksi got to work in her apartment producing prototype face shields by modifying an open-source design, from a company called Budmen Industries, and 3D printing the plastic visor that holds the shield and rests on the forehead with a piece of foam-like material in between. She used supplies purchased from Staples to slap together about six units she then handed off to Elias a day after receiving the email from the doctor. “He took them straight to the hospital and tested them out,” she says, “and he came back and said, ‘Can we have 1,000 more?’” COVID Maker Response set up its headquarters inside the historic 92nd Street Y community center, thanks to a connection Choksi established with director of operations Christopher Bynum. Photo: COVID Maker Response TheThe US continues to struggle to respond to the COVID-19 pandemic, both at a state and federal level. So DIY efforts from academics, hobbyists, manufacturing experts, and professional firms have coalesced around COVID hotspots like New York City to meet the needs of health care workers and others on the front line of the response effort. Some of these initiatives are highly organized, involving partnerships across state lines to source materials and make use of industrial-grade manufacturing facilities. Yet almost all began in the living rooms of people with access to a 3D printer and the ingenuity to put together stopgap measures as existing supply lines struggled to keep up. “In a perfect world, we have coordination across the nation, where we have hotspots and we focus the resources there so the health care workers are protected and patients are protected. And as that dies down, we ship what remains to the next location,” says James Hudspeth, an assistant professor of medicine at Boston University and a COVID response lead at Boston Medical Center. That ideal world is far from reality. Face shields, which Hudspeth says are rarely used in standard medical environments outside surgeries and very select procedures, ended up being second in demand only to face masks, which have also been in short supply. “One way people get infected is by touching surfaces and then touching the face or mask. The shield acts as a reminder you shouldn’t touch your eyes and shouldn’t touch your mouth,” Hudspeth explains. The problem is that shields are only made by a limited number of manufacturers, some domestic but many overseas. And large manufacturers only ship units in batches based on orders from procurement offices of large medical institutions and local and state governments. “We have a central supply, and some of the states have the supply. But there isn’t the capacity to dictate where privately produced or purchased stuff is going,” Hudspeth says. “States are battling each other for these supplies, and every hospital in the country is doing the same thing.” That’s left doctors, nurses, and health care workers across the nation scrambling to get as much PPE as they can, regardless of where it comes from. A face shield of the DIY variety typically consists of a molded or printed plastic semi-circle visor, sometimes called a bracket, that is attached often by glue to a piece of foam that rests on the forehead. The unit then attaches to a long sheet of transparent plastic film that sits just above the face. Everything is held together with a rubber band or a similar elastic device. It’s a simple way to protect someone’s face when interacting with a potentially COVID-positive patient. These shields can be cheaply manufactured, easily sanitized, and then reused. They also aren’t as complicated or bound by regulatory restrictions as, say, respiratory face masks. The lack of regulations surrounding face shields have made them an attractive option for manufacturers large and small looking for a way to pitch in. Apple CEO Tim Cook announced in early April that his company would produce tens of millions of face shields for California health care workers, and Apple’s website now features a tutorial for assembling the units. In the Pacific Northwest, Nike, which has its headquarters just outside Portland, has repurposed materials and manufacturing processes for its running shoes to produce face shields, too. Countless other companies, from Jeff Bezos-funded rocket outfit Blue Origin to Alphabet’s life sciences division Verily, are putting resources toward emergency face shield production. The efforts aren’t stopping at just shields but extending to face masks and even ventilators, too. Razer, the gaming accessory maker, even built its own automated face mask production line in Singapore, equipped with vending machines for dispensing them around the city-state. It doesn’t hurt that out of all the PPE in short supply during COVID-19, face shields are among the easiest to produce — a single unit can be constructed with basic materials by anyone with a 3D printer or even a laser or waterjet cutter. “The nice thing about shields is that they’re easy to produce relatively quickly,” Hudspeth says. “People who have larger 3D printers and a relatively basic piece of plastic that is flexible enough to bend can make a face shield.” NearlyNearly two months after she’d received that first, frantic email, Choksi and her fellow Columbia University librarians Alex Gil and Moacir P. de Sá Pereira now run a DIY volunteer effort called COVID Maker Response. So far, the group has assembled more than 19,000 face shields and distributed units to over 50 institutions, including hospitals, clinics, fire departments, and other groups of first responders. The operation now has an almost factory-like scale and sophistication. They moved from Choksi’s apartment to the 92nd Street Y, a historic community center in Manhattan’s Upper East Side. They have two official manufacturing partners: 3D printing design firm Tangible Creative, out of Newark, New Jersey, and Brooklyn-based 3D printer creator MakerBot. Both firms supply the single 3D-printed visor to which the shield attaches. After receiving the parts in large batches, Choksi has a group of 10 to 12 volunteers, mostly medical students, on four-hour shifts assembling the shields and ferrying them by taxi or car to hospitals. Photo: COVID Maker Response Image: COVID Maker Response Gil and de Sá Pereira, both data librarians and scholars specializing in areas like data visualization and digital mapping, have experience in rapid crisis response through their academic careers. Now, Gil handles incoming face shield requests and spends all day in communication with hospitals. And de Sá Pereira is helping manage the operation’s resources and ensuring they’re using Columbia’s funding as efficiently as possible. The rest of their limited free time is spent helping other groups in the US and overseas start their own DIY operations. “When this whole thing hit, first and foremost in most of our minds was the lack of PPE, which was pretty harrowing in those early days,” says Jason Hill, an emergency room doctor at the Columbia University Irving Medical Center. “In particular, I had a pretty crazy overnight very early on where I had to intubate,” he says, referring to the insertion of a tube into the body, “in the middle of the night without one of the face shields. It was early on and nobody was expecting the onslaught to be that intense at the time, and we burned through our entire stash during the day.” Uptown at the Harlem Hospital Center, Stephen Nicholas, a doctor who came out of retirement to help treat patients during COVID-19, watched as the PPE shortage was fast becoming a crisis of its own. “I cannot tell you how horrible it was,” he says of the situation in late March. His hospital began using a special emergency code, “777 Gold,” over the loudspeaker when a COVID-19 patient had entered respiratory arrest and needed staff attention immediately. The “gold” was to tell hospital workers to wear appropriate PPE due to the heightened risk of infection, but the building was burning through its stash of face masks at an alarming rate. “There were periods every 20 minutes you would hear overhead, ‘777 Gold.’” Nicholas, a former professor at Columbia, heard about Choksi’s efforts through his daughter, a medical student at the school. Gil began helping the doctor coordinate face shield deliveries for his colleagues. “After the first distribution, they were all gone instantly,” Nicholas says. “Second batch was 200. I was out of those in a day and a half. Next was 500, and that lasted about two days.” He says the PPE shortage is no longer as much an issue now that most workers have their own shields they can sanitize and hold onto. Hill, the ER doctor, also found his way to Choksi’s group through word of mouth. He says, as the crisis accelerated, every doctor became acutely aware that acquiring more PPE as fast as possible would be crucial to keeping health care workers safe. COVID Maker Response is now helping supply his hospital with hundreds of these shields every week. “Every few days, I’ll gauge the needs for our particular ERs and ICUs with some colleges and we’ll swing by and get a box of 200 or so of these face shields to drop off,” he says. “When I walk through the ER, the vast majority of people I see are wearing these face shields. At this point it really feels like we have a surplus, which is a wonderful thing to feel.” COVID Maker Response is far from the only operation like this. Choksi and Gil tell me they’ve been in contact with at least three others around New York City alone, and they continue to field messages from others around the country and even overseas that are interested in doing the same. Countless groups have also spun up elsewhere in the US, typically around schools and libraries with the space and resources to set up these makeshift factories. Some, like the Washington State 3D Face Shield Hub and the Illinois PPE Network, have taken similar approaches to coordinating massive, factory-like volunteer efforts that employ individuals in their homes all the way to corporate partners and universities. “Part of our model is not to become the one supplier of face shields,” says Gil. “The idea of this grassroots, distributed model is to help others be able to do what you’re doing so many more distributed teams can aggregate to some kind of impact. This is of course in the absence of industry or city stepping in.” Dr. Stephen Nicholas with fellow doctors, nurses, and staff at Harlem Hospital wearing COVID Maker Response face shields. Photo: COVID Maker Response OneOne hurdle facing the PPE-producing projects is knowing when to shut them down, as more conventional manufacturing methods continue to ramp up. Choksi and Gil say they’re still receiving daily requests for more face shields, and shortages will continue so long as the novel coronavirus continues to overwhelm the US health care system and its hospital and other frontline workers. “I think we’re just going to keep going until the need dies down,” Choksi says. “There’s so many other efforts we’re hearing about, and until we stop receiving requests, our plan is to just keep at it. Full speed ahead until the needs are met.” For Choksi and her partners at COVID Maker Response, the willingness for her volunteers and partners to keep helping has been one of the few glimmers of light in an otherwise awful and often grim situation. She says the maker community and 3D printing in general have shown that they can fill gaps and help vulnerable communities in times of need, using their expertise and ingenuity. From left to right, the core volunteer group has consisted of Jess Ho, Rin Allen, Elisa Mala, Joe de Jonge, Madiha Zahrah Choksi, Rajat Sethi, Matt Car, Victoria Colozzi, and Cullen O Brown. Photo: COVID Maker Response “I think the situation has really shown what 3D printing is capable of, which is not long-term mass production, but filling a need for very rapid production, on-demand and highly customized items,” says Dave Veisz, MakerBot’s vice president of engineering, who now works closely with COVID Maker Response on the volunteer effort. “[COVID-19] has just shown the vulnerability in the global supply chain. The fact that these parts are needed so badly has been eye-opening, as well as the fact that a lot of these parts only come from a handful of factories.” Veisz says that under normal circumstances, you would just injection mold a face shield design and have a factory spin up to mass produce it. “But these things take months,” he says. “It’s been eye-opening to the general public that 3D printing can be used as a stopgap for emergency needs like this and can be used to kickoff production for the item.” Source: 3D printers are on the front lines of the COVID-19 pandemic (The Verge)
  9. Results from the remdesivir COVID-19 trial are out, and it’s good news Recovery time was shortened from 15 to 11 days. Enlarge / Treatment with the antiviral drug remdesivir shortens the recovery time for patients with COVID-19. digicomphoto/Getty Images 149 with 61 posters participating, including story author On Friday, some good news in the fight against SARS-CoV-2 was published in The New England Journal of Medicine. The antiviral drug remdesivir—originally developed as a potential treatment for Ebola—was shown to shorten recovery time for patients infected with the coronavirus. In late April, early results from this phase 3 clinical trial suggested that remdesivir might be of value in treating COVID-19 patients—this new paper confirms that. It's not a cure, but the drug shortened the recovery time from an average of 15 days to 11 days. The trial involved 1,059 COVID-19 patients across 60 different sites in the United States, Europe, and Asia. Five hundred and thirty-eight patients were treated with a 10-day course of remdesivir; the other 521 patients were given a course of placebo on the same schedule. The patients were assessed daily, both to determine the severity of their symptoms as well as any side effects that could be caused by the drug, which interferes with the the virus' ability to copy its RNA. What was this trial looking at? The main thing being measured in this study was how long a patient took to recover, using an eight-point clinical scale that ranged from "not hospitalized," through increasing levels of care required all the way up to "death." Secondary outcomes for the trial looked at mortality at two and four weeks after treatment began, as well as any serious side effects that occurred during the trial. There had been some controversy about the trial because when it started in February 2020, the primary outcome measurement was how well a patient was doing on day 15. However, in late March, the trial's statisticians changed that to a secondary outcome, replacing it with the outcome described above. But these statisticians had no access to the data showing which participants were receiving the drug and which the placebo, nor any knowledge of the outcome data. The tweak to the study's parameters happened because of a growing awareness by scientists during those few weeks that COVID-19 was a more protracted disease than first thought, and therefore it made sense to study recovery over 28 days, not 15. In late April, it was time to look at the initial results of the trial. And these results showed enough of a clinical benefit from remdesivir that the researchers had an ethical obligation to share their initial findings with the broader medical community. This also meant that patients receiving the placebo could be given the drug. 11 days < 15 days Overall, treatment with remdesivir shortened a patient's time to recovery compared to the placebo group, from an average of 15 days to 11 days. Improvements occurred whether or not the patient was receiving supplemental oxygen. What's more, the data lays to rest any worries that remdesivir has to be given very early after the onset of symptoms. In fact, those participants who entered the trial more than 10 days after the onset of symptoms actually showed a better response to remdesivir than those who started being treated during the first 10 days of being symptomatic. The trial's main secondary outcome—how a participant was doing on day 15—also showed that remdesivir was significantly better than placebo. And the total number of deaths was lower in the remdesivir group (21 versus 28) at this point, although that difference was not statistically significant. (An analysis of mortality at day 28 is still ongoing, given that enrollment in the study only ended in late April.) The researchers note that remdesivir treatment is unlikely to be sufficient on its own given that it has, at best, a moderate impact on mortality, so studies that combine the drug treatment with other therapies should be explored. But in comparison to another recent study on the effect of hydroxychlorquine on COVID-19—which suggests that drug causes a marked increase in death—this work should definitely be considered a success. The New England Journal of Medicine, 2020. DOI: 10.1056/NEJMoa2007764 (About DOIs). Source: Results from the remdesivir COVID-19 trial are out, and it’s good news (Ars Technica)
  10. Covid-19 Will Accelerate the AI Health Care Revolution Disease diagnosis, drug discovery, robot delivery—artificial intelligence is already powering change in the pandemic’s wake. That’s only the beginning. On New Year’s Eve of last year, the artificial intelligence platform BlueDot picked up an anomaly. It registered a cluster of unusual pneumonia cases in Wuhan, China. BlueDot, based in Toronto, Canada, uses natural language processing and machine learning to track, locate, and report on infectious disease spread. It sends out its alerts to a variety of clients, including health care, government, business, and public health bodies. It had spotted what would come to be known as Covid-19, nine days before the World Health Organization released its statement alerting people to the emergence of a novel coronavirus. BlueDot’s role in spotting the outbreak was an early example of AI intervention. Artificial intelligence has already played a useful but fragmented role in many aspects of the global fight against the coronavirus. In the past months, AI has been used for prediction, screening, contact alerts, faster diagnosis, automated deliveries, and laboratory drug discovery. As the pandemic has rolled around the planet, innovative applications of AI have cropped up in many different locations. In South Korea, location-based messaging has been a crucial tool in the battle to reduce the transmission of the disease. Nine out of 10 South Koreans have been getting location-based emergency messages that alert them when they are near a confirmed case. In China, Alibaba announced an AI algorithm that it says can diagnose suspected cases within 20 seconds (almost 45 times faster than human detection) with 96 percent accuracy. Autonomous vehicles were quickly put to use in scenarios that would have been too dangerous for humans. Robots in China’s Hubei and Guangdong provinces delivered food, medicine, and goods to patients in hospitals or quarantined families, many of whom had lost household breadwinners to the virus. In California, computer scientists are working on systems that can remotely monitor the health of the elderly in their homes and provide alerts if they fall ill with Covid-19 or other conditions. These snapshots of AI in action against Covid-19 provide a glimpse of what will be possible in the various aspects of health care in the future. We have a long way to go. Truth be told, AI has not had a particularly successful four months in the battle of the pandemic. I would give it a B-minus at best. We have seen how vulnerable our health care systems are: insufficient and imprecise alert responses, inadequately distributed medical supplies, overloaded and fatigued medical staff, not enough hospital beds, and no timely treatments or cures. Health care systems around the world—even the most advanced ones—are some of the most complicated, hierarchical, and static institutions in society. This time around, AI has been able to help in only pockets of excellence. The reasons for this are simple: Before Covid-19 struck, we did not understand the importance of these areas and act accordingly, and, crucially as far as AI is concerned, we did not have the data to deliver the solutions. Let’s look to the future. There are two grounds for optimism. The first is that data, always the lifeblood of AI, is now flowing. Kaggle, a machine learning and data science platform, is hosting the Covid-19 Open Research Dataset. CORD-19, as it is known, compiles relevant data and adds new research into one centralized hub. The new data set is machine readable, making it easily parsed for AI machine learning purposes. As of publication, there are more than 128,000 scholarly articles on Covid-19, coronavirus, SARS, MERS, and other relevant terms. The second is that medical scientists and computer scientists across the world are now laser-focused on these problems. Peter Diamandis, founder of the XPrize Foundation, estimated that up to 200 million physicians, scientists, nurses, technologists, and engineers are now taking aim at Covid-19. They are running tens of thousands of experiments and sharing information “with a transparency and at speeds we’ve never seen before.” The Covid-19 research challenge, also hosted on Kaggle, aims to provide a broad range of insights about the pandemic, including its natural history, transmission data and diagnostic criteria for the virus, and lessons from previous epidemiological studies to help global health organizations stay informed and make data-driven decisions. The challenge was released on March 16. Within five days it had already garnered more than 500,000 views and been downloaded more than 18,000 times. Early in the outbreak in China, Alibaba released that AI algorithm trained on more than 5,000 confirmed coronavirus cases. Using CT scans, it can diagnose patients in 20 to 30 seconds. It can also analyze the scans of diagnosed patients and quickly assess health declines or progress, based on signs like white mass in the lungs. Alibaba opened its cloud-based AI platform to medical professionals around the world, working with local partners on anonymous data for deployment, including modules for epidemic prediction, CT Image analytics, and genome sequencing for coronavirus. With the amount of medical data in the world now estimated to double every couple of months or so, health care was ripe for AI—even before the virus struck. A 2019 study covering 19 countries’ artificial intelligence health care markets estimated a 41.7 percent compound annual growth rate, from $1.3 billion in 2018 to $13 billion in 2025, in six major growth areas: hospital workflow, wearables, medical imaging and diagnosis, therapy planning, virtual assistants, and, lastly but most significantly, drug discovery. Covid-19 will accelerate those trends rapidly. Deep learning—the capability to process massive, multi-model data at high speeds—presents one of the most far reaching opportunities for AI. Deep neural networks, a subtype of AI, have already been used to produce accurate and rapid algorithmic interpretation of medical scans, pathology slides, eye exams, and colonoscopies. I see a clear roadmap of how AI, accelerated by the pandemic, will be infused into health care. The potential goes beyond diagnosis and treatment. Getting appointments, paying insurance bills, and other processes should be much less painful. AI combined with robotic process automation can analyze workflows and optimize processes to deliver significantly more efficient medical systems, improve hospital procedures, and streamline insurance fulfillment. To address the pandemic, AI could automate and accelerate pre-diagnostic inputs by crunching texts, languages, and numbers at machine-level quantity and precision. With sufficient data as a foundation, AI can also establish health data benchmarks for individuals and for populations. From there, it’s possible to detect variations from the baseline. That, in turn, positions us to identify potential pandemics early. It’s not easy. Systems need to be connected so that early alert and response mechanisms can be truly effective. That appeared to be a shortcoming in the early days of the coronavirus outbreak. There are already huge opportunities for using AI models and algorithms for new drug discovery and medical breakthroughs in genomic sequencing, stem cells, Crispr, and more. In today’s pharmaceutical world, there is a hefty price tag to developing a treatment. A huge part of this cost is eaten up by the money and time spent on unsuccessful trials. But with AI, scientists can use machine learning to model thousands of variables and how their compounded effect may influence the responses of human cells. These technologies are already being used in the hunt for a Covid-19 vaccine and other therapies. Insilico Medicine, a Hong Kong–based AI company specializing in drug discovery, was among the first companies to react to Covid-19. The company used its generative chemistry AI platform to design new molecules to target the main viral protein responsible for replication. It published the molecules on February 5. AI and machine learning are ushering in an era of faster and cheaper cures for mankind. Drug discovery and the pharmaceutical industry as a whole will be revolutionized. Early one winter morning in the year 2035, I wake up and notice a bit of a sore throat. I get up and walk to the bathroom. While I brush my teeth, an infrared sensor in the bathroom mirror takes my temperature. A minute after I finish brushing my teeth, I receive an alert from my personal AI physician assistant showing some abnormal measurements from my saliva sample and that I am also running a low fever. The AI PA further suggests that I take a fingertip needle touch blood test. While the coffee is brewing, the PA returns with the analysis that I might be coming down with the flu, one of the two types around this season. My PA suggests two video call time slots with my family doctor, should I feel the need to consult her. She will have all the details of my symptoms when I make the call. She prescribes a decongestant and paracetamol, which is delivered to my door by drone. That future is not as far off as it seems. Soon, as medical science and computer science further converge, we will move into an era of fully autonomous AI when we may expect people to choose wearables, biosensors, and smart home detectors to keep them safe and informed. And as data quality and diversity increase from the wearables and other internet-of-things devices, a virtuous cycle of improvements will kick in. In this world a novel coronavirus could be tracked, traced, intercepted, and cut off before it got going. In perhaps 15 years, many of us will have AI personal assistants in our households to keep us supported for our families’ day-to-day health issues. Robots or drones will deliver medication to our doors. If a surgery or some other medical intervention is needed, usually it will be a robot performing or assisting a human surgeon or doctor. In this future doctors and nurses will focus more on the human tasks that no machine can do. The medical professionals or compassionate caregivers will combine the skills of a nurse, medical technician, social worker, and even psychologist. They will operate the AI-enhanced diagnostic tools and systems, but they will concentrate on communicating with patients, consoling them in times of trauma, and emotionally supporting them through their treatment. In all this there are the key issues of privacy and data protection, particularly when it comes to patients’ records. It would be irresponsible to let useful data sit in their own isolated compartments, instead of extracting their usefulness to serve the progress of our societies. I am a big proponent of using innovative technological solutions to solve newly arisen technology issues, and the good news is that there has been progress made in federated learning, also known as distributed learning. In this framework, patients’ data is stored and never leaves their host health system or hospitals or personal devices, as machine learning models are trained from separate datasets, processed and combined subsequently. Technologies, such as federated learning, homomorphic encryption, and trusted hardware execution environments would further ensure data is computed, transmitted, and stored to meet preferred settings, as privacy requirements vary around different countries and cultures. If nothing else, Covid-19 has proven that our shared challenges call for AI that recognizes how intertwined our destinies are. In the past global collaboration has led to the eradication of smallpox and the near-eradication of polio. As we work toward the goal of mitigating, treating, and eradicating the pandemic, it is clear that public health does not stop at national borders. Medicine is an arena where every country will benefit from building on, and with, others’ research. The whole world’s data will generate the most robust insights into health and disease. AI will help ensure we will be better prepared for the next pandemic. It will need medical scientists, AI scientists, investors, and policy makers to collaborate. Venture capital is going to pour into healthcare and provide fresh impetus and focus for smart entrepreneurs and researchers. And, perhaps, as our brightest minds work on this challenge together, we can emerge acknowledging that our common enemy is not each other but a virus. It will take a planet to move our global healthcare systems to the next level. Source: Covid-19 Will Accelerate the AI Health Care Revolution (Wired)
  11. Google and Apple Reveal How Covid-19 Alert Apps Might Look As contact tracing plans firm up, the tech giants are sharing new details for their framework—and a potential app interface. Public health officials still have to make the actual apps. But Apple and Google have given them a reference interface—and strict guidelines on how much data they can collect.Illustration: Getty Images Finding out that you've been exposed to a serious disease through a push notification may still seem like something out of dystopian science fiction. But the ingredients for that exact scenario will be baked into Google and Apple's operating system in as soon as a matter of days. Now the two companies have shown not only how it will work, but how it could look—and how it'll let you know if you're at risk. On Monday, Apple and Google released a few new details about the Bluetooth system they're building into both Android and iOS that will let health care authorities track potential encounters with Covid-19. The companies have now made clear that only government agencies—preferably at the national level, Google and Apple say, though they note they're willing to work with state and regional authorities—will be granted permission to the feature's application programming interface. If those government-run apps want access to Apple and Google's Bluetooth-based system, they won't be allowed to collect location data, and must ask for consent before collecting information on a user's proximity to others. They'll need permission to upload any information from the phones of Covid-19 positive people as well. The two companies have published sample user interface screenshots for the first time as well. As Google and Apple first outlined last month, their Covid-19 exposure notification system transmits unique, rotating codes from phones via their Bluetooth radios based on cryptographic keys that change daily. They not only keep a log of the last two weeks of your codes, but also listen for the codes broadcast by others. If two people running the app spend a certain amount of time in proximity—say, 10 minutes within six feet, or whatever health care agencies dictate—their phones will both record each others' Bluetooth codes. If one of them later receives a positive Covid-19 diagnosis, they can choose to upload all of their keys from the last two weeks to the app's server, which will then send those keys out to the phones of all the other users in their region. Those phones will then check if the codes they've recorded from other nearby users can be generated from those keys. If you get a match, the app will show a message that you've potentially been exposed to Covid-19 and caution you to self-quarantine or get tested. Now Google and Apple are showing how some parts of that process might look. The two companies warn, however, that they're only releasing sample images as references, since health care agencies will build the final apps, not Apple and Google. Here, for instance, is how Google and Apple suggest the apps ask for user consent to transmit and record Bluetooth codes when the app is first installed: Courtesy of Apple In another series of screenshots, the companies show how the apps will likely work when a user is diagnosed as Covid-19 positive. As Apple and Google had suggested earlier, they'll require users to enter a unique code provided by health care providers or a Covid-19 testing lab before allowing them to declare themselves as infected, since otherwise trolls or mistaken self-diagnoses could flood the system with false positives: Courtesy of Apple Finally, Google and Apple have shown an example of what a notification of potential contact with an infected Covid-19-positive person could look like: Courtesy of Apple Those sample messages confirm that Google and Apple will make it possible to determine the exact day a contact event occurred. Some developers of contact-tracing apps have argued that offering too much information about the time when a contact event happened will make it too easy to identify Covid-19-positive people, and that apps should only tell the user they've been exposed at some indeterminate time in the last two weeks. But others have pointed out that users should know when a contact event occurred so that they can consider factors like whether they were wearing a face mask or other personal protective equipment at the time, whether they were behind a protective barrier, or some other situation that might creative a false positive. By choosing to tell users the day—but not the time—that they were potentially exposed, Google and Apple appear to have reached a compromise. But the system still leaves open the possibility that some people could have their Covid-19-positive status exposed to strangers without their consent. Someone who is sheltering in place might leave their home only once daily to get their mail, for instance, and come into contact with just a few people—or even just one person. If they're later alerted they were exposed to Covid-19 that day, they might be able to remember which of their neighbors they saw and learn who has likely been diagnosed with Covid-19. That's just one of the potential pitfalls of Google and Apple's system. Security researcher Ashkan Soltani has pointed out, for instance, that someone could set up cameras and bluetooth beacons to identify Covid-19 positive users. The Electronic Frontier Foundation has warned that hackers could record and rebroadcast users' contact codes to feed false information into the system willy-nilly, though it's not clear what they'd accomplish with that system other than nihilistic trolling. But when it comes to privacy preservation, Google and Apple's system is nonetheless one of the most conservative of all the schemes that developers have proposed to use smartphones for contact-tracing or exposure notification. By focusing on only Bluetooth-based proximity detection, it avoids the privacy peril of collecting location information. And it doesn't upload anything to the server at all for the vast majority of users who aren't diagnosed as Covid-19 positive. All of their information stays on their phone. Apple and Google's system will likely only work if it's part of a much larger picture, one that includes widespread testing, social distancing, and manual contact-tracing. But it could serve as one piece in that system, another tool to help the world return normalcy. Now that the companies are publishing samples of the warnings they'll give to users and the consent they'll ask from them, people can start to judge for themselves if they're willing to put that tool in their pocket. Source: Google and Apple Reveal How Covid-19 Alert Apps Might Look (Wired)
  12. The Ars COVID-19 vaccine primer: 100-plus in the works, 8 in clinical trials Here's where we are and what may lie ahead for a vaccine against COVID-19. Enlarge / HUBEI, CHINA - APRIL 15: (CHINA MAINLAND OUT)220 volunteers from Wuhan are vaccinated with the novel coronavirus vaccine, which is in a human clinical trial. Getty | TPG 99 with 61 posters participating The clearest way out of the COVID-19 crisis is to develop a safe, effective vaccine—and scientists have wasted no time in getting started. They have at least 102 vaccine candidates in development worldwide. Eight of those have already entered early clinical trials in people. At least two have protected a small number of monkeys from infection with the novel coronavirus, SARS-CoV-2, that causes COVID-19. Some optimistic vaccine developers say that, if all goes perfectly, we could see large-scale production and limited deployment of vaccines as early as this fall. If true, it would be an extraordinary achievement. Less than four months ago, SARS-CoV-2 was an unnamed, never-before-seen virus that abruptly emerged in the central Chinese city of Wuhan. Researchers there quickly identified it and, by late January, had deciphered and shared its genetic code, allowing researchers around the world to get to work on defeating it. By late February, researchers on multiple continents were working up clinical trials for vaccine candidates. By mid-March, two of them began, and volunteers began receiving the first jabs of candidate vaccines against COVID-19. It’s a record-setting feat. But, it’s unclear if researchers will be able to maintain this break-neck pace. Generally, vaccines must go through three progressively more stringent human trial phases before they are considered safe and effective. The phases assess the candidates’ safety profile, the strength of the immune responses they trigger, and how good they are at actually protecting people from infection and disease. Most vaccine candidates don’t make it. By some estimates, more than 90 percent fail. And, though a pandemic-propelled timeline could conceivably deliver a vaccine in as little as 18 months, most vaccines take years—often more than 10 years, in fact—to go from preclinical vetting to a syringe in a doctor’s office. Abridging that timeline can up the risk of failure. For instance, vaccine candidates usually enter the three phases of clinical trials only after being well tested in lab animals that can model the human disease. But, with such a new virus, there is no established animal model for COVID-19. And amid a devastating pandemic, there’s not enough time to thoroughly develop one. Some researchers are now doing that ground-level animal work in parallel with human trials—such as the small monkey trials mentioned above. Researchers already have reason to be a little anxious about the safety of any COVID-19 vaccine. When they tried in the past to make vaccines against some of SARS-CoV-2’s coronavirus relatives, they found a small number of instances when candidate vaccines seemed to make infections worse. That is, these candidate vaccines seemed to prompt berserk immune responses that caused lung damage in monkeys and liver damage in ferrets. Researchers still don’t fully understand the problem and don’t know if it could happen in humans, let alone if it will show up with the new candidate vaccines against SARS-CoV-2. But we may soon know the answers. As the pandemic tops the grim milestone of three million cases worldwide and well over 200,000 deaths, researchers are relentlessly moving forward with vaccine development. Here's where the scientific community currently stands in its frenetic effort. First, the basics Researchers are using a wide variety of tools and techniques to develop a vaccine—some are tried and tested, others are fresh and unproven. Regardless of the strategy, they all aim to do the same thing: train the immune system to identify SARS-CoV-2 (or some element of it) and destroy it before it establishes an infection and causes COVID-19. The way a vaccine can pull this off, typically, is by feeding immune cells a signature element of a disease-causing germ, such as a unique protein that coats the outside of a dangerous virus. From there, a type of white blood cell called B cells can generate antibodies that specifically recognize and glom onto those signature germ elements. Antibodies are Y-shaped proteins, which have their germ-specific detecting regions on their outstretched arms. The base of their “Y” shape is a generic region that can signal certain immune responses if they detect an invading germ. A strong, effective vaccine can generate so-called neutralizing antibodies. These antibodies circulate in the blood, surveilling the whole body after a vaccine is given. If the germ they’re trained to detect actually shows up, the antibodies can swarm and paralyze it. The base of the antibodies—now dangling off their smothered target germ—can then signal immune cells to help finish the job. In the case of COVID-19, the goal of candidate vaccines is to train our immune systems to make antibodies that specifically detect and destroy SARS-CoV-2 (which is, again, the novel coronavirus that causes COVID-19). Though there’s a lot we don’t know about SARS-CoV-2, we know enough of the basics to direct early vaccine development. We know that SARS-CoV-2 is a betacoronavirus related to two other notorious betacoronaviruses: SARS-CoV-1, which causes SARS (severe acute respiratory syndrome), and the Middle Eastern respiratory syndrome coronavirus (MERS-CoV), which causes MERS. Coronaviruses, generally, keep their genetic blueprints in the form of a large, single-stranded, positive-sense RNA genome, which is bundled into a round viral particle. That genetic code provides the molecular instructions to make all of the components of the virus, including enzymes required to make copies of the virus’s genome, and the virus’s famous spike protein. The spike protein is what the coronaviruses use to grab ahold of host cells—that is, human cells they infect or the cells of any other animal victim. Once the virus latches on with its spike protein, it gets into the cell and hijacks the cell's activities, forcing it to help manufacture viral clones, which then burst forth to infect more cells. There are many copies of the spike protein on the outer surface of coronaviruses, creating a spikey exterior—think a cartoon sea mine. The pointy adornments are actually what give coronaviruses their name. Under an electron microscope, the spikes give the viral particle a crown-like appearance, hence corona viruses. But more importantly, the spike proteins are a prime target for antibodies. And, because we have the whole genome sequence for SARS-CoV-2, researchers have a good start at figuring out effective ways to engineer vaccines to attack the spike proteins and other critical components of the virus. Vaccine platforms There are many ways to try to train the immune system to fight off a specific germ or specific elements of germs, such as SARS-CoV-2 or the SARS-CoV-2 spike proteins. Here are the general categories currently in play: Live-attenuated vaccine: These vaccines use whole viruses that are weakened so they can no longer cause disease. This is a well-established method for creating vaccines. In the past, researchers weakened viruses by growing them in lab conditions for long periods of time—which is a bit like domesticating germs. The cushy, all-inclusive petri-dish lifestyle can essentially allow viruses and bacteria to adapt to their tranquil surroundings and lose virulence over time. But, it can take a while. Scientists grew the measles virus in lab conditions for nearly 10 years before using it for a live-attenuated vaccine in the early 1960s. Nowadays, there are faster, more controlled approaches to engineer weakened viruses, such as targeted mutations and other manipulations of a virus’s genetic code. Live-attenuated virus vaccines have the advantage of generating the same variety of protective antibodies as a real infection—without causing a pesky, life-threatening disease, for the most part. But there are risks. Because the virus can still replicate, certain people (particularly those with immunodeficiencies) may have severe reactions. Though the newer strategies for weakening viruses may reduce these risks, they still require extensive safety testing before reaching the market. That said, this is a vaccine platform that has already proven successful. Several vaccines in use are live-attenuated vaccines, including vaccines for chickenpox and typhoid. If such a vaccine proved effective at preventing COVID-19, we already have the know-how and infrastructure to quickly scale up production to make these vaccines. Inactivated vaccine: This is another straightforward, old-school method that uses whole viruses. In this case, the viruses are effectively dead, though, usually inactivated by heat or chemicals. These corpse viruses can still prime the immune system to make neutralizing antibodies; they just do it less efficiently. The advantage of this strategy is that it is relatively simple to make these types of vaccines and, because the viruses don’t replicate, there is no risk of infection and less risk of severe reactions. Disadvantages include that inactivated, non-replicating viruses don’t elicit as strong of an immune response as a disease-causing or weakened virus. Inactivated vaccines always require multiple doses and may need periodic booster shots as well. Like weakened virus vaccines, using a whole viral particle gives the immune system many potential viral targets for antibodies. Some may be good targets to neutralize a real infection, and some may not. But, using an inactivated virus is a proven method. For instance, some existing vaccines against polio, hepatitis A, and rabies use this method. Viral vector-based vaccine: For these vaccines, researchers take a weakened or harmless virus and engineer it to contain an element of a dangerous virus they want to protect against. In the context of COVID-19, this might mean engineering a harmless virus to produce, say, the spike protein from SARS-CoV-2. This way you get the immune response to a live but benign virus, coupled with the likelihood of having antibodies that target a specific critical protein from the dangerous SARS-CoV-2. This, too, is a proven strategy for effective vaccines. The newly approved Ebola vaccine, for instance, uses this method. Subunit vaccines: These are bare-bones vaccines that include only a component of a dangerous virus to elicit immune responses. For COVID-19 vaccines, the spike protein is—no surprise—a popular candidate. Subunits can be delivered in formulations with adjuvants—accessory ingredients that can enhance immune responses. One common adjuvant is alum, an aluminum salt, long known to be useful for vaccines. Some newer subunit vaccines come in snappier packages, however. These include artificial “virus-like particles” (VLPs) and nanoparticles. Subunit vaccines are already an established vaccine platform. The HPV vaccine in use involves a VLP that feeds the immune system proteins from the HPV’s outer shell—which can then be targeted by antibodies. RNA and DNA vaccines: These are among the newest types of vaccines—and among the shakiest. There are currently no licensed vaccines that use this method. But researchers are optimistic about their potential. The basic idea is to deliver genetic material of a virus—either in the form of DNA or RNA—directly to human cells, which are then somehow compelled to translate that genetic code into viral proteins and then able to make antibodies against those. Some of the details of how these candidate vaccines work are proprietary and unproven, so it’s difficult to assess how likely they are to succeed or how easy it will be to scale up vaccine production if they are successful. Enlarge / Adapted from a review of candidate vaccines. This includes information about vaccine development that is not publicly available. It is a larger list of candidates than what is reported by the WHO. Ars Technica Potential pitfalls As mentioned earlier, in some previous work on developing a vaccine against SARS-CoV-1—the virus behind SARS—researchers came across a few instances where candidate vaccines seemed to make disease worse in animal models. This led to some instances of organ damage in a few animal models, namely monkeys, ferrets, and also mice. So far, it’s unclear what was going on there. Some researchers have speculated that it may be a form of Antibody-Dependent Enhancement (ADE). Very generally, this is a scenario in which the immune system makes antibodies against an invading germ, but those antibodies are not able to neutralize the germ completely. This can make the situation worse if the shoddy antibodies signal for immune cells to respond while the germ is still infectious. Basically, the antibodies are just recruiting immune cells to be the germ’s next victims. And this, in turn, can lead to additional—excessive—immune responses that end up damaging the body. One of the best understood examples of this occurs with dengue viruses. There are four types of dengue viruses that circulate (in people and mosquitoes), and research suggests that some antibodies to one type of dengue may sometimes generate ADE in subsequent infections or exposures with other types of dengue. This is why researchers think that some patients with dengue fever, which can be a mild disease, go on to develop dengue hemorrhagic fever. This is a rare but severe form of the disease in which immune cells release chemicals called inflammatory cytokines that end up damaging the circulatory system, leading to blood plasma leaking out of capillaries. From there, the patient can go into shock and die. But, many researchers are not convinced that ADE is behind some of the problems seen with early SARS vaccines—nor that ADE will necessarily be an issue with a COVID-19 vaccine. For one thing, the berserk immune responses seen in the animal models don’t seem to involve some of the same immune system components seen in well-understood cases of ADE, like dengue. “There’s no clear evidence that ADE is an issue,” microbiologist Maria Elena Bottazzi tells Ars. Bottazzi is the associate dean of the National School of Tropical Medicine at Baylor College of Medicine. Instead, Bottazzi and colleagues hypothesize that something about the coronaviruses and whole-virus vaccine candidates may induce an excessive, aberrant inflammatory response, potentially through the activity of specialized, pro-inflammatory immune cells called T helper 17 cells, which are linked to inflammatory autoimmune diseases. This may help explain why some patients with the most severe forms of COVID-19 seem to experience so-called “cytokine storms,” which are like a disastrous deluge of pro-inflammatory signals unleashed by the immune system that end up causing damage to the body—just like in the animal models. Much of this is still speculative, but Bottazzi says what we know so far may be helpful for directing vaccine development strategies. She notes that the excessive immune responses may mainly occur when the immune system is presented with a whole, intact coronavirus particle. Something about interacting with that whole particle may send our immune systems into a tailspin, the thinking goes. A safer strategy may be to use a subunit vaccine or another more targeted approach to train our immune systems—an approach that only shows the immune system what it needs to see to defeat the virus. Many vaccine developers are already on board with this thinking, it seems. Bottazzi notes that most of the candidates in development now do not involve the whole virus, but subunits, genetic material, or other targeted strategies. “Having the whole virus, of course it has higher risks, so the new platforms are actually selecting for better candidates,” she says. Bottazzi and her colleagues are themselves now working up such a subunit vaccine candidate for SARS-CoV-2, which follows up on their vaccine work for SARS-CoV-1. The vaccine includes just a portion of the SARS-CoV-2 spike protein—the precise segment that actually binds to human cells. She notes that further questions about potential ADE or excessive immune responses to any candidate vaccine might be more closely looked at further along in vaccine development, perhaps in phase II trials. But, right now, “it’s not a high-ranking concern,” she says. Timing Another potential problem vaccine developers should keep in mind is how long the antibody responses may last in the body. Past research has suggested that coronaviruses that cause just common colds—there are four strains of these that circulate in humans—don’t prompt long-lasting antibodies. A person may only be protected for a few years. Ideally, vaccines should be optimized to generate the strongest immune response possible that will, hopefully, offer long-lasting if not life-long protection. But, if immune responses to an otherwise effective vaccine wane over time, and SARS-CoV-2 becomes an endemic disease or comes in seasonal waves, we may have to look at periodic boosters until a more effective vaccine is developed. We already have annual vaccines for influenza, but this is because the influenza virus mutates so quickly that our immune system may not recognize strains from one year to the next. Also, there are different mixes of strains circulating from season to season. Both of these issues lead to the need for season-specific vaccine formulations. So far, SARS-CoV-2 does not seem to be mutating in a particularly fast or problematic fashion, suggesting that we may not need seasonal shots—at least not for these reasons. Early front-runners With all of this in mind, vaccine developers have charged ahead. There are currently at least 102 candidates, and eight of them are in clinical trials. One of the earliest was an RNA vaccine, called mRNA-1273, from biotechnology company Moderna. As we mentioned earlier, vaccines based on genetic material are unproven so far. Moreover, because the technology is so new, much of it is still proprietary, so outside researchers don’t know a lot about how these vaccines work. As such, they’re difficult to assess from the outside—and it’s difficult to know how easy it will be to scale up production for worldwide vaccination campaigns (if they work), Bottazzi says. Based on what we know about Moderna’s work, their vaccine contains the genetic blueprints for the SARS-CoV-2 spike proteins. The genetic code is modified to have artificial components—such as pseudouridine instead of RNA’s usual uridine—so that the immune system doesn’t automatically recognize the vaccine as foreign genetic material and try to destroy it. The genetic material is also packaged for cell delivery in a lipid nanoparticle. Moderna, working with the National Institutes of Health, got a clinical trial set up in February and gave its first doses to humans on March 16. If all goes to plan, the company has suggested that it could have a vaccine ready for frontline healthcare workers by this fall. Eight candidate vaccines in clinical evaluation Platform Type of candidate vaccine Developer Current stage of clinical evaluation/regulatory status—coronavirus candidate Same platform for non-coronavirus candidates Non-replicating viral vector Adenovirus Type 5 Vector CanSino Biological Inc./Beijing Institute of Biotechnology Phase 2: ChiCTR2000031781 Phase 1: ChiCTR2000030906 Ebola Non-replicating viral vector ChAdOx1 University of Oxford Phase 1/2: NCT04324606 MERS, Influenza, TB, Chikungunya, Zika, MenB, plague DNA DNA plasmid vaccine with electropolation Inovio Pharmaceuticals Phase 1: NCT04336410 Multiple candidates Inactivated Inactivated Wuhan Institute of Biological Products/Sinopharm Phase 1: ChiCTR2000031809 Inactivated Inactivated Beijing Institute of Biological Products/Sinopharm Phase 1 (regulatory approval) Inactivated Inactivated + alum Sinovac Phase 1: NCT04352608 SARS RNA mRNA BioNTech/Fosun Pharma/Pfizer Phase 1/2: 2020-001038-36 RNA LNP-encapsulated mRNA Moderna/NIAID Phase 1: NCT04283461 Multiple candidates Source: WHO Meanwhile, in China, biotechnology company CanSino Biologics began a trial March 17 for its viral vector-based vaccine candidate. The strategy packages genetic material from SARS-CoV-2 into a weakened adenovirus strain. The company has already gotten to work on a Phase II trial. Beijing-based Sinovac Biotech made headlines this month after its whole-virus inactivated SARS-CoV-2 vaccine candidate was shown to protect a small number of monkeys from COVID-19 in early lab tests. Its Phase I clinical trials in humans began on April 16. The results are positive, but some researchers are anxious to see more testing and safety data. Researchers at Oxford University are also off to a good start with their viral vector-based vaccine candidate. They have packaged the SARS-CoV-2 spike protein in a weakened adenovirus, similar to CanSino’s approach. And like Sinovac, their vaccine has protected a small number of monkeys in early lab experiments. Oxford researchers began dosing trial participants last week. The researchers told The New York Times that if the trials go to plan, they could produce millions of doses by September. The latest, ever-expanding and updating list of candidate vaccines assembled by the World Health Organization can be found here. Source: The Ars COVID-19 vaccine primer: 100-plus in the works, 8 in clinical trials (Ars Technica)
  13. Watch 3D printers churn out medical supplies to fight COVID-19 Goodbye prototyping, hello mass production In the past decade, 3D printing has occupied some interesting niches. It’s an invaluable prototyping tool for countless industries and has found regular use in architecture, biotech, prosthetics, and plenty of other disciplines. The rise in consumer-grade printers has also given rise to a vibrant maker community. But for the most part, the technology has remained a niche tool instead of a household name. Then came the COVID-19 pandemic. Hospitals around the world faced frightening shortages of medical equipment — essentials like face masks and shields, testing swabs, ventilators, and more. While traditional supply chains scrambled to react, 3D printing outfits large and small have begun chipping away at the short-term demand. Most 3D printers can’t churn out inventory as quickly as other manufacturing methods like injection molding, but they can produce a wide variety of designs without the need for new molds or retooling. By sharing equipment designs and pooling resources, members of the 3D printing community have banded together to become something of a manufacturing hive mind during this pandemic. The Verge spoke with a variety of 3D printing professionals about their abrupt shift to this unique form of “wartime production.” Check out the video above to see what they’ve accomplished. Source: Watch 3D printers churn out medical supplies to fight COVID-19 (The Verge)
  14. The US CDC has published a new advisory revealing that two pet cats have been diagnosed with mild cases of COVID-19, the respiratory disease caused by the novel coronavirus. The cats are both located in New York, according to the CDC, which says these are the first pets in the nation to test positive for the virus. Experts expect both cats, which are located in different parts of the state, to recover. The announcement was made in conjunction with the USDA’s National Veterinary Services Laboratories (NVSL) on Wednesday. This statement joins select reports of other animals around the world that have tested positive for the virus. Both cats were identified as having mild respiratory illnesses; the first cat was tested by a vet after showing signs of the virus. In that case, none of the humans who lived in the household had been confirmed to have COVID-19. The second cat, meanwhile, also started showing symptoms of the virus and was tested. In this case, the cat’s owner had also tested positive for the disease before the cat started showing symptoms, indicating it may have passed from the owner to the pet. That particular household had two cats, but the second pet didn’t show any signs of the condition. Once the positive results were available from the veterinary lab, they were passed on to state and federal officials, prompting a confirmation testing from the NVSL. According to the CDC, there isn’t any evidence at this point that pets are spreading the virus within the US, but it’s unknown how different animals may be impacted by the virus. At this point in time, the agency is advising the public to keep their pets away from other people and animals who live outside of the household. As well, cats should ideally be kept indoors and dogs should be kept at a distance from other people and animals when outdoors. The CDC says that owners should also avoid dog parks at this time. source
  15. Americans would receive $2,000 stimulus check each month through COVID-19 crisis under proposed legislationOHIO (WJW) — Rep. Tim Ryan (D-OH) and Ro Khanna (D-CA) introduced legislation Tuesday that would provide a $2,000 monthly payment to qualifying Americans until employment returns to pre-COVID-19 levels. According to a press release, the Emergency Money for the People Act would mean $2000 monthly payments for those over the age of 16 who make less than $130,000 annually. The release states that while the CARES Act was “an important first step” to help those impacted by the pandemic, “it does not provide nearly enough support for American families.” The release said the act also fixes a “bug” in the CARES Act to ensure college students and adults with disabilities can still receive the payments even if claimed as a dependent. The release also states: “The Emergency Money for the People Act additionally recognizes that not everyone has a bank or a home address to receive a check – so it allows individuals to get this money through direct deposit, check, pre-paid debit card, or mobile money platforms such as Venmo, Zelle, or PayPal.” “The economic impact of this virus is unprecedented for our country. As millions of Americans file for unemployment week over week, we have to work quickly to patch the dam – and that means putting cash in the hands of hard-working families,” Ryan said in the release. “Many Ohioans are just receiving – or about to receive – the first cash payment we passed in the CARES Act. Now it’s time for Congress to get to work on the next step to provide relief for those who have been hardest hit in this pandemic.” Eligibility factors would include: Every American adult age 16 and older making less than $130,000 annually would receive at least $2,000 per month. Married couples earning less than $260,000 would receive at least $4,000 per month. Qualifying families with children will receive an additional $500 per child – families will receive funds for up to three children. For example, a married couple making under $260K with 3 kids would receive $5,500 per month. Those who had no earnings, were unemployed, or are currently unemployed would also be eligible. Those who were not eligible in 2019 or 2018 but would be eligible in 2020, could submit at least two consecutive months of paychecks to verify income eligibility. The Emergency Money for the People Act also expands the program to millions more Americans who were excluded from the CARES cash rebates – such as college students and adults with disabilities who are still claimed as a dependent. The individual will receive the payment and their parent or guardian will receive the dependent credit. Source: https://fox8.com/news/americans-would-receive-2000-stimulus-check-each-month-through-covid-19-crisis-under-proposed-legislation/
  16. WWE pro wrestling deemed ‘essential business’ in Florida By Kenneth Garger April 13, 2020 | 9:52pm | Updated Enlarge Image WWE resumed live shows without fans in Florida on Monday night as the entertainment service was reportedly deemed an “essential business” that can remain open during the state’s stay-at-home order. Orange County Mayor Jerry Demings made the announcement at a Monday press briefing, according to ESPN, saying the ruling was made after “some conversation” with Florida Gov. Ron DeSantis’ office. “I think initially there was a review that was done. They were not initially deemed an essential business,” Demings said. “With some conversation with the governor’s office regarding the governor’s order, they were deemed an essential business. So therefore they were allowed to remain open.” WWE, which is filmed in Orlando and Winter Park, had been airing taped shows since the state’s order was implemented on April 1, the report said. “We believe it is now more important than ever to provide people with a diversion from these hard times,” the WWE said in a statement. “We are producing content on a closed set with only essential personnel in attendance following appropriate guidelines while taking additional precautions to ensure the health and wellness of our performers and staff,” the statement continued. A spokesman for Desantis told ESPN that WWE and other nationally viewed sports and media production services were declared essential “because they are critical to Florida’s economy.” Source: https://nypost.com/2020/04/13/wwe-deemed-an-essential-business-in-florida/
  17. Florida chief on leave for allegedly blaming gay cop's coronavirus death on sexuality Police Chief Dale Engle.Davie Police Dept. Davie police Chief Dale Engle has been placed on administrative leave after officers at his Florida station filed a union complaint alleging that he dismissed their concerns about coronavirus protection measures and blamed the coronavirus fatality of a Broward County deputy sheriff on his sexuality. Engle allegedly blamed the death of openly gay Broward County Deputy Sheriff Shannon Bennett on a “backstory," claiming he died because he was a “homosexual who attended homosexual events." Source: Read the full story here.
  18. Kentucky troopers placed notices on the vehicles of parishioners attending an in-person Easter service at Maryville Baptist Church. (Photo: Courier Journal) HILLVIEW, Ky. — As Maryville Baptist Church moved forward with its in-person Easter service Sunday morning, Kentucky State Police troopers were recording the license plates and placing notices on the roughly 50 cars parked outside of the congregation. The action related to license plates came as a result of an order that Gov. Andy Beshear announced Friday as part of ongoing efforts to keep Kentuckians from further spreading COVID-19. Following Beshear's license plate order, which applies anyone who attends an in-person church service or any mass gathering, police will refer those motorists to local health departments, which will then order 14-day quarantines – although several attendees told The Courier Journal they have no intention of following the order. Sgt. Josh Lawson of KSP said most of the state’s 16 posts have responded to between two and five complaints about church services. But so they’ve found no violations of CDC guidelines and no in-person services, with Maryville apparently the exception. Most calls have been in reference to outdoor services, where people were in cars and not passing between cars. Those types of services “were specifically mentioned by the governor as being allowed,” he said. “We’re responding to those calls as we would any other calls for service. As of now, we have not found anyone to be in violation when we responded to those calls. They are following the proper guidelines,” he said. Maryville was the only place plates have been recorded and notices put on cars that he knew about. He couldn’t answer what exactly they will do with them, but noted the action was the directive of the governor. Troopers have used community connections to speak with pastors to advise that “they can worship while doing so safely and within proper guidelines.” Lawson said it’s been “very non-confrontational.” More than an hour before Maryville Baptist Church began worship, the Rev. Jack Roberts had to call for help to clean up piles of nails scattered at the entrances to the church parking lot. 137 people are talking about this The nails appeared to have been dumped at the entrances to block cars from entering the church that is in the Bullitt County community of Hillview, just south of the Jefferson County line. Roberts had been determined to move forward with the 11 a.m. Easter service at Maryville Baptist Church despite repeated pleas from Kentucky Gov. Andy Beshear to shift to virtual services and a March 19 executive order prohibiting faith-based mass gatherings amid the novel coronavirus pandemic. Background: Kentucky church leader vows to hold Easter services Earlier this week, the Baptist congregation also received a state-backed order from the Bullitt County Health Department to cease in-person gatherings "immediately." But the church has not backed down during this Holy Week, holding a Wednesday evening service that drew roughly 40 attendees. Buy Photo Nails, screws and carpenter tacks were found in various spots of the Maryville Baptist Church parking lot on Easter morning. April 12, 2020 (Photo: Scott Utterback/The Courier Journal) Beshear's order for police to record license plates has drawn criticism from numerous Republicans who represent Kentucky at the state and federal level, including Sen. Rand Paul and Rep. Thomas Massie as well as Kentucky Attorney General Daniel Cameron. Roberts has said he is "not interested in trying to defy the government," but believes his church has a constitutional right to continue to hold worship services inside his church. More news: Judge allows drive-in service at Louisville church, says Fischer 'criminalized' Easter "If you read the Constitution of the United States, if you read the constitution of the state of the Kentucky, they both say that (Beshear) is infringing on the church's rights," Roberts said earlier this week. On Sunday, Roberts said he would not encourage or discourage compliance with any quarantine orders. The pastor did cover the license plate on his own vehicle. Just after 10 a.m., when Sunday school was beginning, no law enforcement could be spotted outside of the church. Five or so cars were initially parked in the church's lot, with a few more lined up on the outskirts. Several vehicles had covered up their license plates. A KSP official at the church said officers recorded VIN numbers of cars that had their plates covered. Some of the cars parked at the Maryville Baptist Church for Easter service had their license plates covered. April 12, 2020 (Photo: Scott Utterback/The Courier Journal) Beshear has mentioned in recent weeks how numerous churches have held mass gatherings in defiance of his order that is aimed at limiting the spread of the COVID-19 virus. On the eve of Easter Sunday, Beshear said he knew of only seven mass gatherings planned for the weekend. "To our knowledge, 99.89% of all churches and all synagogues and all mosques in Kentucky have chosen to do the right thing," Beshear said during his Saturday briefing. "I'm just doing my best to save lives. And there aren't easy answers." The governor added that the state is not going to "padlock doors or arrest pastors." Recording license plate numbers, he said, is an effort to "say that if you’re going to make the decision to go to a mass gathering during this pandemic, it shouldn’t affect other people." In Louisville, Mayor Greg Fischer reiterated Saturday that he was "strongly suggesting" churches don't host in-person or drive-in services this Easter weekend. Fischer had said Friday that Louisville Metro Police officers would record the license plate numbers of those who attend church services and the local health department would use that information to contact attendees, should any later fall ill with COVID-19. The mayor pointed to photos published in The Courier Journal of a March 29 service at On Fire Christian Church, 5627 New Cut Road, that show some individuals within 6 feet of each other. Beshear: Mass gatherings, such as in-person church, will lead to self-quarantine orders Although Fischer did not issue an order banning drive-in services, one Louisville church sued the mayor and city on Friday, arguing Fischer's recommendations on drive-in religious services violated constitutional rights and their religious freedoms. U.S. District Judge Justin Walker, who was appointed to the Western District of Kentucky bench last year with Sen. Mitch McConnell's recommendation, sided with On Fire Christian Church in a Saturday ruling, calling Fischer's move overly broad and unconstitutional. "On Holy Thursday, an American mayor criminalized the communal celebration of Easter," Walker wrote in a temporary restraining order he issued, which bans the city from "enforcing; attempting to enforce; threatening to enforce; or otherwise requiring compliance with any prohibition on drive-in church services at On Fire." In response to Walker's order, Fischer repeated that hasn't directed law enforcement to shut down drive-in worship services. The mayor also said the city tried to present evidence to Walker in defense of its position but was unsuccessful. On Sunday morning, On Fire Christian Church pastor Chuck Salvo stood on a podium above 100 or so cars in the parking lot, starting the Easter morning service by singing “God Bless the U.S.A.” and waving the red, white and blue flag to a chorus of honks from churchgoers. Before getting into his resurrection sermon, Salvo said he recognized that government officials “are up against a tremendous challenge” and led the congregation in a prayer. He then recited the CDC guidelines for drive-in services. Source: https://www.courier-journal.com/story/news/2020/04/12/kentucky-churches-hold-in-person-easter-services-despite-order/5127260002/
  19. FDA warns Alex Jones to stop promoting false coronavirus claims and cures The U.S. Food and Drug Administration sent a warning letter to internet and radio personality Alex Jones on Thursday, urging him to stop promoting false claims about coronavirus preventatives and cures on his InfoWars website. The federal agency said products misleadingly advertised as safe and effective treatments, or as guards against the coronavirus, include silver-based gargles and toothpaste. Jones has 48 hours to respond and the FDA is threatening legal action for failure to comply. Jones, a media mogul and notorious conspiracy theorist, has amassed a fortune through supplements and survivalist products sold on the InfoWars site. Jones is currently being sued in multiple states by parents of children killed in the Newtown, Connecticut, mass shooting for using his website and show to promote the false conspiracy theory that the attack was a hoax. In March, New York Attorney General Letita James sent Jones a letter demanding he cease and desist selling supplements and creams under false coronavirus claims. The FDA has not yet approved any vaccines or treatments for COVID-19, the disease associated with coronavirus. Source: https://www.nbcnews.com/health/health-news/live-blog/2020-04-09-coronavirus-news-n1179786/ncrd1180716
  20. Why Does Covid-19 Make Some People So Sick? Ask Their DNA Consumer genomics company 23andMe wants to mine its database of millions of customers for clues to why the virus hits some people harder than others. Illustration: Casey Chin SARS-CoV-2, the pandemic coronavirus that surfaced for the first time in China last year, is an equal opportunity invader. If you’re a human, it wants in. Regardless of age, race, or sex, the virus appears to infect people at the same rate. Which makes sense, given that it’s a totally new pathogen against which approximately zero humans have preexisting immunity. But the disease it causes, Covid-19, is more mercurial in its manifestations. Only some infected people ever get sick. Those who do experience a wide range of symptoms. Some get fever and a cough. For others it’s stomach cramps and diarrhea. Some lose their appetite. Some lose their sense of smell. Some can wait it out at home with a steady diet of fluids and The Great British Baking Show. Others drown in a sea of breathing tubes futilely forcing air into their flooded lungs. Old people, those with underlying conditions, and men make up the majority of the casualties. But not always. In the US, an alarmingly high fraction of those hospitalized with severe symptoms are adults under the age of 40. Kids, and in particular infants, aren’t invincible either. To understand what accounts for these differences, scientists have been scouring the patchy epidemiological data coming out of hotspots like China, Italy, and the US, looking for patterns in patients’ age, race, sex, socioeconomic status, behaviors, and access to health care. And now, they’re starting to dig somewhere else for clues: your DNA. On Monday, 23andMe launched a new study intended to illuminate any genetic differences that might help explain why people who’ve contracted Covid-19 have such varying responses to the infection. The consumer genomics company joins a number of emerging academic projects aimed at answering the same question. Prior research indicates that some gene variants can put people at higher risk for certain infectious diseases. Others offer protection, like the CCR5 mutation that makes people who carry it resistant to HIV. At this point, it’s too early to say how big a role DNA might play in vulnerability to Covid-19. But these findings may one day be used to identify people with higher risk for the most serious symptoms and to sharpen the search for potential new treatments. “We want to understand how your genes influence your response to the virus,” says Joyce Tung, 23andMe’s vice president of research. “Our hope is that by collecting data from people who’ve been tested and diagnosed with Covid-19, that we can learn something about the biology of the disease that we can contribute to the scientific community to help them treat people more successfully.” While other at-home DNA testing companies have converted their shuttered labs into Covid-testing operations, 23andMe decided to leverage a unique asset: its database of more than 10 million customers, 80 percent of whom have given consent for their genetic information and other self-reported details to be used for research. The company has spent years building out a platform that makes it easy to push out surveys en masse to this trove of potential study participants. As a result, each genetic profile comes with hundreds of phenotypic data points—like how many cigarettes a customer has smoked in their lifetime or whether anyone in their family has ever been diagnosed with diabetes. The sheer volume of data that 23andMe has at its disposal has powered the company’s leap into drug discovery, and made it a genetic research publishing powerhouse. The latest survey to go live on 23andMe’s customer portal asks questions about where people live, what kinds of social distancing they’ve been doing, and whether or not they have been tested for, diagnosed with, or exposed to Covid-19. (The survey is only open to 23andMe customers in the US.) Company officials hope to enroll hundreds of thousands of customers in the study, including those who have tested positive, those who have tested negative, and those who have experienced flulike symptoms but not yet been tested—as well as those whose family members have experienced infections. People who have tested positive will receive a follow-up survey about the severity of their symptoms and whether or not they were hospitalized, according to Adam Auton, a principal scientist at 23andMe who is heading up the new Covid-19 study. Anyone who participates will get invited back each month to answer more questions, so 23andMe can capture any new cases that develop among this cohort over time. If the company collects enough responses from people who’ve contracted Covid-19, 23andMe’s research team will conduct a statistical analysis called a GWAS, or genome-wide association study. A mainstay of genetic research, GWAS involves sorting people into different groups—in this case probably based on symptoms—and scanning their DNA data to see if certain single-letter variations in the genetic code show up more often among people with certain symptoms. If that happens a significant number of times, they can say with some confidence that those variants are linked to those symptoms. It’s hard to predict what sorts of genes will get unearthed during these DNA mining expeditions, but many of them will likely map back to regions of the genome responsible for orchestrating the body’s immune response, says Michael Snyder, chair of the genetics department at Stanford University, who is not affiliated with the 23andMe research. “In general, we know that genetics do influence the course of a viral infection,” he says. That’s to be expected, he adds, given that over history humans evolving in different environments have been exposed to distinctive pathogens. “It’s logical that immune systems are tuned differently inside different people,” he says. (In fact, a dangerous immune overreaction known as a cytokine storm caused the deaths of many SARS patients and is suspected to be responsible for some of the fatalities among young Covid-19 patients.) Another potential candidate is the gene that codes for the ACE2 receptor. Found on the surface of lung and other human cells, it’s the molecular doorway through which SARS-CoV-2 infiltrates the body. Small variations in this gene may result in versions of the receptor that are easier or more difficult to unlock. Alternatively, variations in the regions of the genome that turn the ACE2 gene on or off might also play a role. Less gene activity would mean the person’s cells have produced fewer receptors for the virus to grab onto. At this point, it’s too early to venture guesses about the role genes play in determining Covid-19 outcomes, says Snyder. But he is willing to bet that projects like 23andMe’s probably won’t turn up a single genetic variant that determines whether or not someone winds up in the intensive care unit. “I’d be surprised if they find anything as strong BRCA,” he says, referring to one of the most powerful cancer predictors scientists have discovered; mutations in BRCA genes quadruple a person’s likelihood of getting certain forms of breast cancer. That’s because GWAS is a numbers game. It’s best at identifying mutations that occur over and over again throughout a population, with each exerting only a very small effect on an individual person’s disease susceptibility. And because GWAS are usually performed on the kind of limited genetic data 23andMe collects—a snapshot of about 600,000 locations in the genome—these common variants are easier to pick out than rare ones. But it’s these very rare mutations that are likely driving cases of extreme susceptibility to Covid-19, says Stephen Chapman, a respiratory physician and researcher at the University of Oxford’s Wellcome Trust Centre for Human Genetics, who isn’t part of the 23andMe project. In the mid-2000s, he conducted some of the first genetic studies on susceptibility to bacterial pneumonia, and discovered rare mutations in immune-related genes that made otherwise healthy children and adults especially susceptible to an invasion by one particular bacteria. Chapman suspects similarly rare mutations involved in immune function or inflammatory responses could be what’s putting young, apparently fit adults without other risk factors into ICU beds. “This is the major drawback of GWAS, in my view,” he says. “It will miss those rare, causative mutations.” Finding them will require collecting blood from these extreme outliers and sequencing their entire genomes. Decoding the DNA from young adults strapped to ventilators might reveal a unique genetic vulnerability to Covid-19. Conversely, DNA from the octogenarians who’ve tested positive for Covid-19 but experienced no symptoms might contain protective mutations to the worst forms of the disease. More than 90 such sequencing projects are already underway in academic labs around the world, as scientists have raced to understand a disease whose global death toll has now surpassed more than 76,000. Some are existing population genetics studies that follow thousands of volunteers for years, like the UK Biobank. DeCODE Genetics, an Icelandic company that has been collecting genome and health data on the island nation’s 364,000 inhabitants for decades, has also received government permission to release its Covid-19 testing results, according to Science. Others are new studies dedicated solely to Covid-19 patients. To pool all the genetic data streaming in from these various projects, researchers at the University of Helsinki recently launched a central clearinghouse called the Covid-19 Host Genetics Initiative. With more data comes more statistical power, increasing the hope of finding mutations that might alter a person’s experience of the new disease, as well as the course of humankind’s battle against it. But don’t expect to get a genetic scorecard for Covid-19 risk anytime soon. Chapman says the most likely outcome of all these studies won’t be having the ability to identify more susceptible people based on their DNA. Rather, it will be a better understanding of the molecular pathways involved in severe forms of Covid-19. “With a new, devastating human disease, there is an urgent need to understand the biology,” says Chapman. Mapping the genes that direct different immune responses may reveal targets for novel therapies or help doctors provide more tailored care to individual patients. “Both GWAS and whole genome sequencing approaches can play a valuable role here,” says Chapman. Age, underlying health problems, access to early testing and quality care—these things will matter most of all in determining who lives and who dies from Covid-19. But DNA almost certainly plays a role in shaping disease outcomes. And there’s still everything left to learn about it. WIRED is providing free access to stories about public health and how to protect yourself during the coronavirus pandemic. Sign up for our Coronavirus Update newsletter for the latest updates, and subscribe to support our journalism. Source: Why Does Covid-19 Make Some People So Sick? Ask Their DNA (Wired)
  21. Husband of accidental ‘Thanksgiving grandma’ dies of coronavirus The woman who became known on the internet as the “accidental Thanksgiving grandma” — when she mistakenly texted a teen she’d never met to invite him to her holiday dinner — is now recovering from the coronavirus as she mourns the loss of her husband. In 2016, Wanda Dench, from Mesa, Arizona, invited then 17-year-old Jamal Hinton to Thanksgiving when a misfired text went to him instead of one of her grandchildren. But even after realizing the gaffe, Wanda, along with her husband, Lonnie, extended their invite to Hinton and his girlfriend, Mikaela, that year — and every subsequent year. The two became as close as family in the years since she sent the serendipitous text, and Hinton shared each milestone of their bond with his more than 51,000 followers. Last year, their annual tradition included Hinton’s family, too, for the first time. Hinton’s and Mikaela’s party did all the cooking for the Dench family. Wanda, meanwhile, had a surprise for Hinton — a scrapbook of memories they share together, that all started with a viral tweet. But today, Wanda, afflicted with COVID-19, is in the hospital. Her partner, Lonnie, has tragically already succumbed to the virus. On April 1, Hinton tweeted to his 50,000 followers that his adoptive grandparents were both fighting for their lives against the coronavirus. “I am so sad to announce that Wanda and Lonnie both have COVID-19 and that Lonnie is currently in the hospital fighting both COVID and Pneumonia please send words of love and encouragement their way,” he wrote, alongside photos of himself and Mikaela with the Denches. Jamal Hinton with Wanda and Lonnie Dench.Twitter Last night, Hinton returned with a tragic update on the husband and wife. “As some of you may have already found out tonight Lonnie did not make it… he passed away Sunday morning,” he tweeted late Wednesday night. “But Wanda told me all the love and support he was receiving put a huge smile on his face so I thank every single one of you guys for that!” He later replied to his thread, “Also for those asking, Wanda is not sick,” indicating that Wanda is regaining health. Social media responded in kind — clearly devastated to learn of the undue suffering of the internet’s favorite big-hearted grandma and grandpa. Apparently, Hinton and Wanda aren’t the only ones feeling the loss. “The holidays are REALLY hard for me & their story brought a lot of joy to me. My heart hurts for them so much,” wrote one such follower. “Thank you for sharing this piece of your life and family with us for so long. Peace be unto you and them. Amen,” tweeted another. source: https://nypost.com/2020/04/09/husband-of-accidental-thanksgiving-grandma-dies-of-covid-19/ Poster's note: [To see the full tweets in this article please visit the link above]
  22. Apple will battle COVID-19 by designing and making millions of medical face shields Company joins GM, Tesla, startups, and more to make supplies to battle COVID-19. Apple CEO Tim Cook took to a Twitter video to announce that the company will design and make face shields for medical workers battling the COVID-19 crisis, to the tune of one million shields per week. This announcement follows already publicized efforts to source face masks from the company's supply chains; Cook said that effort has produced 20 million face masks to date. "We've launched a company-wide effort bringing together product designers, engineering, operations, and packing teams and our suppliers, to design, produce, and ship face shields for health workers," Cook explained in the two-minute video. He added that one shipment has been delivered to Kaiser hospital facilities in the Santa Clara valley and that the company expects to make one million face masks by the end of the week and just as many each following week. Cook went on to explain that the shields "pack flat, one hundred to a box" and that each shield can be assembled in under two minutes. Both materials and manufacturing will be sourced from the United States and China, Apple's two primary countries of operation. For now, Apple is distributing the masks within the United States, but Cook said the company hopes to expand to other countries and regions in the future. He ended his statements by encouraging viewers to follow local guidelines to shelter in place and maintain social distancing to slow the spread of the virus. Apple is not the only company putting some resources toward producing critical supplies for the response to COVID-19. Tesla announced plans to work on ventilators, GM has worked at sourcing face masks, and many 3D printing startups have found their moment in this crisis, to name a few. Even some brewing companies have pivoted in full or in part to producing hand sanitizer. The range of corporate responses to the crisis ranges from positive efforts like this to negative ones like mass layoffs or even efforts to profit off of the crisis. Listing image by Justin Sullivan/Getty Images Source: Apple will battle COVID-19 by designing and making millions of medical face shields (Ars Technica)
  23. Face masks for COVID-19: A deep dive into the data With all the talk of masks, here's what the data really says. Enlarge / Self-sewn protective face masks in a fabric store on April 3, 2020 in Jena, Germany. Getty | Jens Schlueter 256 with 131 posters participating, including story author As COVID-19 cases increase sharply nationwide, some health experts are now recommending that seemingly healthy members of the public wear cloth masks when they’re out and about. On April 3, President Trump announced a new federal recommendation urging the public to wear cloth masks to prevent people who are infected, but may not have symptoms, from unknowingly spreading the disease. The recommendation is an about-face from previous guidance on mask usage. Until now, officials at the World Health Organization, the US Centers for Disease Control and Prevention, and other agencies worldwide have discouraged the public from wearing masks unless they are sick or caring for someone who is sick. They noted that there is little evidence to support mass masking and that the limited data we do have suggests it may reduce disease transmission only marginally at best. With evidence of benefits in short supply, experts also raised concerns about potential harms. Mask wearing may give people a false sense of security, some experts said. This may lead some members of the public to be lax about other, far more critical precautions, such as staying two meters apart from others, limiting outings, and washing their hands frequently and thoroughly. Moreover, donning an uncomfortable, awkward mask may lead some people to touch their faces more, some argued. Any face touching has the potential to transfer virus particles from contaminated hands to entry points, such as the eyes, nose, and mouth. And even if a mask-wearer’s hands are clean to begin with, simply touching their mask could contaminate their hands if there are viral particles caught on the outside. If that’s the case, a mask wearer could then transfer virus particles from their mask to their face unwittingly—negating any benefit of having the mask. They might also transfer the virus from their mask to their environment by touching surfaces, where the virus particles could get picked up by other people. Last, they argued, the masks that would be most effective at stopping the new coronavirus—SARS-CoV-2—are things like N95 respirators and surgical masks, which are in short supply worldwide. Without question, these should be preserved for the heroic frontline health workers, who are putting their lives at risk every day to treat patients with COVID-19 during this overwhelming pandemic. While experts unanimously agree on that last point—that proper medical masks should go to healthcare workers first—the other points are now up for debate. With SARS-CoV-2 now spreading widely and unchecked through communities nationwide, experts are taking a more favorable look at the limited data behind masks preventing disease spread among the public. In a recent a commentary in The Lancet, a group of UK and Hong Kong researchers argue that “there is an essential distinction between absence of evidence and evidence of absence.” And though there are no large, high-quality studies looking at public mask usage, there is some data to support mask usage. As for potential harms of mask wearing—such as fraught face fussing and wearers relaxing other precautions—experts are now dismissing the concerns. Wearing a mask in public could keep people alert to current health risks in public, some experts say. A conspicuous mask strapped to your head is a constant reminder right over one’s nose to be mindful of possible viral transmission. And—as a bonus—if everyone wears a mask, it could lessen the chances of stigma of those who wear them because they are sick. Of course, wearing a mask does not replace other interventions, like staying two meters apart or practicing good hand hygiene, says Joseph Allen, an expert of exposure assessment science in the Department of Environmental Health at Harvard T.H. Chan School of Public Health. “It’s just one more layer of protection.” “The scale and scope of what we’re facing requires or mandates taking every precaution we can,” he says. As such, some experts—Dr. Allen included—are now in favor of having the healthy public wear home-made cotton masks or other face coverings that could act as a basic physical barrier. “It’s not as good [as medical masks], but it’s better than nothing,” Dr. Allen argues. So with the conflicting reasoning and logic, what does the data on masks actually show? How were they dismissed before but embraced now? Here’s a rundown of pertinent data. Transmission First, to understand why masks could be helpful at blocking SARS-CoV-2 transmission, it’s important to understand how the coronavirus is transmitted. And, frankly, we still don’t know all the answers to this question. So far, SARS-CoV-2 mainly appears to move from one human to another by being launched in relatively large respiratory droplets. These are unleashed when an infected person breathes, talks, coughs, or sneezes. These droplets are relatively heavy, they generally don’t travel much farther than two meters away from their launch site, and they follow a ballistic trajectory, that is, they fall toward the ground after blast off. But if they land on a person’s face before that or fall to a surface a person will soon touch, they could cause a new infection. There’s also the possibility that SARS-CoV-2 can spread in smaller respiratory droplets called aerosols (less than 5 micrometers). These are droplets we exhale that are so small they can hang in the air for minutes to hours. Experts at the WHO and elsewhere say that the data so far suggests aerosol transmission is not the primary way the virus spreads, though it is still possible. So far, it appears aerosol transmission is mainly a concern for healthcare workers while they’re performing certain medical procedures on COVID-19 patients, such as placing a tube in their airway to aid breathing (intubation). This may create circumstances for the virus to aerosolize and linger in the air in hospital rooms. Whether SARS-CoV-2 is aerosolized in everyday settings is still unknown and up for debate. Some experts, such as Dr. Allen, believe that it could be happening. Others are more skeptical of the idea given that infected people only infect two to three other people on average. If each COVID-19 patient were creating infectious clouds of SARS-CoV-2 wherever they went, some experts would expect the patients would infect far more people on average. Measles, for instance, has been associated with airborne transmission for decades and each measles patient, on average, may infect 12 to 18 people—or more. There’s even evidence the measles virus can disperse through ventilation systems. Though that doesn’t appear to be the case for SARS-CoV-2, experts like Allen caution that the size of virus-containing respiratory droplets is a continuum, not subject to clear cut-offs or strict rules. There is evidence that if SARS-CoV-2 does make it into aerosols, the virus can survive in the air for hours in laboratory conditions. Last, there’s evidence that SARS-CoV-2 particles that land on surfaces or objects can loiter and potentially be picked up by others. These contaminated surfaces and objects that can then transfer the infectious virus particles are called fomites. Masks may keep a wearer from putting a fomite-contaminated hand to their face, but masks may also act as fomites. Enlarge Aurich Lawson / Getty Filtration by N95 respirators, surgical masks, and homemade masks N95 respirators get their name from their National Institute for Occupational Safety and Health (NIOSH) designation. They contain filter material that uses electrostatic attraction to thwart particles of all sizes. The N in the name means the masks are not resistant to oil and the 95 refers to their efficiency. To get a 95 designation, a mask has to filter out at least 95 percent of all particles. Specifically, the designation is granted if the mask proves to filter out at least 95 percent of particles in the size range it is least efficient at filtering out in standard conditions. This is considered “worst case” testing. In one 2014 study, researchers compared the effectiveness of 44 masks, including N95 equivalent respirators, surgical and dental masks, general cotton masks, and handkerchiefs. They used particle penetration tests similar to those used by NIOSH and the European Union. They found that the N95 equivalent mask blocked more than 95 percent of all particles, as expected. The surgical mask was around 40 percent effective, with the dental masks coming in at around 60 percent. Cotton masks were around 30 percent effective and cotton handkerchiefs ranged from 2 percent (one layer) to 13 percent (four layers). A similar study in 2010 by NIOSH researchers looked at masks made of different types of fabrics. They found that masks made from t-shirts blocked about 10 percent of particles in a wide range, masks made from sweatshirt fabric blocked 20 to 40 percent, masks made from towels blocked around 40 percent, and scarves blocked 10 to 20 percent. In a study published April 3, 2020 in Nature Medicine, researchers found that surgical masks reduced the detection of respiratory viruses in aerosols generated by infected people breathing or coughing in a breath-collecting machine. Masks in the real world Overall, the body of research on mask efficacy in real-world settings is small and scattershot. And because SARS-CoV-2 was completely unknown to humanity just five (extremely long) months ago, there is no data on the efficacy of any type of mask wearing in any setting (healthcare or home) for this virus. As such, any relevant data has to be gleaned from studies looking at other respiratory illnesses and how various masks in various settings play a role. Masks on healthy people In a 2011 randomized clinical trial, researchers monitored 1,441 healthcare workers in 15 Beijing hospitals to compare the rates of respiratory infections if they wore either a surgical mask or an N95 respirator during their shifts. They compared infection rates in the two masked groups to a convenience sample of 481 healthcare workers who didn’t wear masks. Overall, both masked groups had fewer respiratory symptoms, influenza-like illnesses, and confirmed viral infections than the control group. The rates of illness were approximately double in those who wore surgical masks compared with those who wore N95 respirators, though. For instance, about 9 percent of non-mask wearers reported respiratory symptoms compared with about 7 percent of surgical mask wearers and 4 percent of N95 wearers. But with such small infection rates overall, there was limited power to detect differences, and the authors note that the findings may not hold up in other settings. Enlarge / Dawn Canova, clinical manager for outpatient wound care at Carroll Hospital, takes samples from people to test them for the coronavirus at a drive-thru station in the hospital's parking garage while wearing a medical grade mask. Chip Somodevilla Masks on sick people The push to preserve medical-grade masks for healthcare workers is intended to try to protect them from contracting illnesses from their patients. But the push for public face mask use is powered by the desire to prevent sick people from spraying respiratory droplets around and potentially sicken others. This has become a greater concern as more evidence has pointed to apparent symptomless spread of COVID-19. That is, people who don’t show symptoms (either asymptomatic or pre-symptomatic) may be able to pass on the infection without knowing it. While there is evidence that this is happening in some cases, it’s still very unclear how often it happens. Estimates of how many cases are spreading stealthily like this have ranged from between 25 percent of cases to over 60 percent. Experts at the WHO, though, continue to say that people who are coughing or sneezing are still most likely to be the ones passing on the virus. In a 2016 randomized controlled trial, researchers examined whether wearing a surgical mask could keep people with influenza-like illnesses (ILI) from passing the infection on to members of their household. Those household members were not asked to wear masks and the researchers didn’t collect data on it. The study included 123 ILI patients who were instructed to wear masks at home around other household members and 122 ILI patients who didn’t wear masks. The masked and unmasked ILI patients were in households with, on average, 2.5 or 2.4 members, respectively. While the infection rates in home of masks-wearing patients were consistently lower than those in the homes of unmasked patients, the numbers were too small to be statistically significant. “The study indicates a potential benefit of medical masks for source control but is limited by small sample size and low secondary attack rates [subsequent infections],” the authors concluded. “Larger trials are needed to confirm efficacy of medical masks as source control.” Masks on everyone With the new recommendations, everyone may be wearing masks, which has also been examined in a number of studies. In 2008, a randomized controlled trial led by researchers in Hong Kong looked at the effect of blanket mask wearing on the spread of flu within households. They started with 198 households with one confirmed case at the beginning. Of those households, 127 were told that all household members should wear masks around each other. In 35 households, members were instructed to adhere to hand hygiene protocols and the remaining 36 households were controls.The researchers found little difference in infection spread among all three groups. In 2009, researchers led by a group in Australia followed up with a similar randomized controlled study. The group looked at the spread of influenza-like illness to 286 adults in 143 households with a sick child. Participants were either assorted into a control group, a surgical mask group, or a more protective mask. Overall, they detected no difference in infection rates among the three groups. They noted that at least half of masked participants didn’t adhere to wearing the mask. Another randomized controlled trial in 2009 followed people in 259 households in Hong Kong. Collectively, the households started with 407 household members with flu and 794 uninfected contacts. The households were randomly assorted to either all wear surgical masks, practice hand hygiene, or act as controls. Overall, the interventions didn’t lead to statistically significant differences in the spread of infections within the households. But when they looked at households that started using masks quickly (within 36 hours) after the onset of flu symptoms in a member, they did see a statistically significant reduction in infection spread. Likewise, in a 2012 randomized controlled trial involving 84 households in Germany, researchers again found no difference in disease spread among household members that used masks, masks and hand hygiene, or were in a control group. However, when they did a separate analysis just looking at the households who fully implemented mask wearing or mask wearing and hygiene within 36 hours of onset of symptoms in their first case, they did note a lower chance of transmission than what was seen in controls. Cloth masks While most studies have looked at the effectiveness of surgical masks and other medical-grade masks, a few have ventured to look at cloth and homemade masks. In a 2015 randomized controlled trial involving 1,607 healthcare workers, researchers compared the rate of influenza-like illness in healthcare workers wearing cloth masks or medical masks to those in a control group (which sometimes used masks). Wearing cloth masks resulted in significantly higher rates of infection, the authors found. They also noted that in their test, the cloth masks were only 3 percent effective at blocking particles. Potential risks of masks There is evidence that virus particles hang out on the outside of masks—particularly among healthcare workers who likely have high exposure. Among 59 healthcare workers who had their protective gear, clothes, and skin sampled in a 2019 study, many were contaminated with virus. Overall, 31 percent of gloves, 21 percent of gowns, and 12 percent of face masks were positive for virus. Moreover, 11 percent had viral particles on their scrubs and 7 percent had them on their bare faces. A similar study, also in 2019, confirmed that respiratory viruses are often found on the outside surface of medical masks and can be a source of self-contamination. In yet another study from last year, researchers in Chicago observed healthcare workers taking off their person protective equipment (masks, gloves, gowns, etc)—the removal is called doffing. This is a time when healthcare workers can easily self-contaminate by taking gear off incorrectly. The researchers found that healthcare workers incorrectly removed their protective gear 90 percent of the time. If you do wear a mask, be sure to remove it from behind your head. Don’t touch the surface of the mask. If you do touch the surface, immediately wash your hands or use hand sanitizer. Update 4/3/2020, 6:20pm ET: This post was updated to include the new federal recommendation for the public to wear cloth masks. Source: Face masks for COVID-19: A deep dive into the data (Ars Technica)
  24. The CDC Now Recommends Americans Wear Face Masks Staying home is still the best way to protect yourself from the coronavirus. But the CDC now says that masks are effective as an additional measure. Photograph: ISAAC LAWRENCE/Getty Images On Friday, the US Centers for Disease Control and Prevention recommended that citizens should wear "non-medical, cloth masks" to help prevent the spread of the coronavirus. Previously, the CDC had recommended that only those with Covid-19 symptoms wear masks. The agency now recommends that those who aren't feeling sick should still wear a mask, though compliance is voluntary. In a statement on its website, the CDC says: "Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure." The word "additional" is key here; sheltering in place is still the most effective way to protect yourself and those in your community, and the agency recommends maintaining 6-fot social distancing as the primary method of reducing exposure. This new policy comes on the heels of new research about how the virus is transmitted, and with cases on the rise across the US, there's some evidence that people who aren't showing any symptoms can still be spreading the virus as they move about in public. This week, cities like New York and Los Angeles have also recommended that all residents wear face coverings in public, whether they're showing signs of sickness or not. Specific guidance has been issued for Los Angeles (and California as a whole) and New York City. These policy recommendations are happening at a time when surgical face masks and N95 masks are already in critically short supply. This scarcity of protective equipment has been devastating for health care workers busy treating patients, and many fear that a nationwide decree to wear a mask could strain supplies even more. If you live in a community where masks are recommended, or if you are caring for a loved one who's currently sick, you should make your own mask. Do not buy N95 masks, and absolutely do not hoard supplies that medical professionals need. It's important to remember that cloth face coverings like those recommended by California's Department of Public Heath may help unknowingly infected people from transmitting the virus, but there is no guarantee they can prevent a healthy person from becoming infected. Staying Home Is Still Most Important Wearing a mask is a last-resort measure. A mask is not a virus-blocking solution that will allow you to return to normal social interactions. We all still need to stay home as much as possible until shelter-in-place orders have lifted. If you do have to go outside for supplies, stay 6 feet away from other people, and continue washing your hands and disinfecting your home. So what should you wear? According to the CDC, a well-made mask that is snugly secured around the ears is best. Alternatively, any type of face covering like a bandana or scarf is better than nothing if you have to go out, although the CDC cautions that these are not considered proper protective gear and should only be used as a last resort. In either case, you want to be sure your nose and mouth are securely covered from all sides so droplets can't escape. Some health care workers have taken to wearing homemade masks over their N95 masks to lengthen its lifespan. A few hospitals have put out calls asking for home-sewn donations, like University Hospitals in Ohio, or Deaconess Hospital in Evansville, Indiana, which has also set up a nationwide database to connect heath care facilities in need with those who can make masks and donate them. If you can sew, consider making and donating face masks to your local hospital. The online marketplace Etsy has also asked its sellers to switch to making masks, but has offered crafters a number of precautions, like forbidding them to resell medical equipment and telling them not to make medical claims about home-sewn masks. WIRED is providing free access to stories about public health and how to protect yourself during the coronavirus pandemic. Sign up for our Coronavirus Update newsletter for the latest updates, and subscribe to support our journalism. Source: The CDC Now Recommends Americans Wear Face Masks (Wired)
  25. Plastic bags are making a comeback because of COVID-19 There’s no evidence of reusable bags spreading the novel coronavirus, but people are being cautious Photo by Fiona Goodall / Getty Images With grocery stores being one of the few places still open during COVID-19 lockdowns, disposable plastic bags are making a comeback as some people fear that reusable bags could spread the disease. Before the pandemic, a growing number of governments banned single-use plastic bags in an effort to cut down on waste. But as the novel coronavirus has spread around the globe, people have gotten leery about coming in close contact with other people and their possessions, including reusable bags. On March 31st, New Hampshire became the first state in the US to temporarily ban reusable bags during the pandemic. “For whatever reason, people seem to get very fired up about grocery bags,” says Meghan May, a professor of microbiology and infectious disease at the University of New England College of Osteopathic Medicine. “Ordinarily I use [reusable bags] all the time because I live in a beach town and a clean ocean is really important,” May tells The Verge. But now she and many others are thinking twice. Like pretty much everything else right now, reusable bags should probably be handled more carefully to minimize the risk of transmitting disease to other people. At the same time, there has been no evidence so far that using reusable grocery bags have been responsible for spreading the novel coronavirus. We don’t really know how long the novel coronavirus can persist on reusable bags. The best data experts have is from one study that found that the virus could stay viable on plastic for up to three days in lab conditions. (That means shoppers may want to be careful when handling disposable plastic bags, too, environmental advocates contend.) That research didn’t look into how the virus fares on fabric, so we can’t apply its findings directly to cloth bags, according to May. Shoppers should still take precautions with reusable bags, despite the lack of data, May advises. “One would want to err on the side of caution here because we know [the virus] can survive on many different types of surfaces,” she says. “We should probably assume that it can be transmitted that way until someone demonstrates that it can’t.” One way to stop the spread of germs is to wash reusable bags before and after each use. (That’s in addition to washing your hands before and after you go to the store, avoiding touching your face, wiping down baskets and carts, and bagging your own items.) Plastic and nylon bags can be cleaned with soap and water, then sprayed or wiped down with a diluted bleach solution or disinfectant, according to recommendations from North Carolina State University. Make sure to clean both the inside and outside of the bag and let them air dry before storing or using them, the university adds, and cloth bags can be washed like laundry, then they should be dried on the warmest setting. But the virus could transfer quickly from one person to an item they’ve been in close contact with, like a bag, reusable or otherwise, May points out. If an infected person hands the bag to someone else, they risk passing along the virus. The person who faces the most risk, according to May, is the grocery store worker interacting with many customers throughout his or her shift. “They have to touch [the reusable bag], handle it and pack things into it, and then they have to then turn around and do that with the next customer that comes in their line,” May says. “The person at least risk is the person who owns the bag.” That’s why some grocery stores and states are turning back to disposable bags: they simply aren’t handled quite as much, so there’s less uncertainty over where they’ve been. But protecting public health doesn’t have to be at odds with efforts to stem the flood of plastics filling landfills and collecting in the ocean, environmental advocates say. “If stores, particularly workers, want to keep themselves as safe as possible and limit the bags coming in because they don’t know if people wash them, certainly a temporary pause on that, I think that’s understandable,” Ivy Schlegel, a senior research specialist for Greenpeace USA, says. But that “pause” shouldn’t be permanent, says Schlegel. She has followed the plastics industry’s history of fighting environmental reforms by claiming that reusable bags are unsanitary. She sees the industry seizing the opportunity now to push its own agenda. A frequently cited 2011 study that found bacteria in seldom-washed reusable bags was actually underwritten by a fossil fuel and chemical industry group, the American Chemistry Council. It was cited in a March 18th letter that the Plastics Industry Association penned to the Department of Health and Human Services asking that the department “speak out against bans on [single-use plastic] products as a public safety risk.” “Some people will call it disaster capitalism,” says Schlegel. “Using this moment where everything is in chaos and people are legitimately concerned about public health to turn back the clock to go back to a world where plastic is the norm, rather than right now where reusables are becoming the norm in many places.” The plastic pollution problem isn’t going away anytime soon. A plastic grocery bag adrift in the ocean can take up to 20 years to decompose. A plastic bottle could stick around for up to 450 years, according to estimates from the National Oceanic and Atmospheric Administration. Less than 10 percent of all plastics have actually been recycled. The industry knew all along that recycling wouldn’t solve the environmental harms posed by plastic, but it continued to promote it as a viable solution anyway, according to a joint investigation by PBS Frontline and NPR published this week. There are ways to limit plastic waste during the COVID-19 pandemic. May recommends simply carrying groceries straight from the basket or cart to your car if that’s possible. Paper bags are another alternative; they are still single-use, but at least they’re compostable. And Schlegel tells The Verge that one way to make reusable bags cleaner and more convenient in the future could be to implement municipal programs that pick up residents’ reusable bags, sanitize them, and then return them to stores for reuse. Those solutions might not be available everywhere during this pandemic, but they’re worth thinking about as we prepare for what comes next. In the long run, protecting public health and the planet usually go hand in hand. Source: Plastic bags are making a comeback because of COVID-19 (The Verge)
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